The role of high-dose melphalan with autologous stem-cell transplant in multiple myeloma: Is it time for a paradigm shift? Review


Authors: Kazandjian, D.; Mo, C. C.; Landgren, O.; Richardson, P. G.
Review Title: The role of high-dose melphalan with autologous stem-cell transplant in multiple myeloma: Is it time for a paradigm shift?
Abstract: Recent advances in multiple myeloma include numerous approvals of novel therapies with unprecedented efficacy, a rapid and sustained tempo of new drug development, and further refinements to prognostication to include minimal residual disease (MRD) testing and improved risk stratification. The upfront use of immunomodulatory drug and proteasome inhibitor combinations followed by maintenance has resulted in transformative clinical benefit. Four-drug regimens incorporating monoclonal antibodies are reporting unprecedented rates of complete response and MRD negativity in the absence of intensification. In the context of these advances, the added value of high-dose melphalan with autologous stem-cell transplant (HDM-ASCT) is a key question. From a safety standpoint, HDM-ASCT is associated with both acute toxicities that reduce quality of life and long-term toxicities that may limit life expectancy for some patients. The present review discusses the recent advances in induction therapy, the impact of these advances on HDM-ASCT, the evolving role of MRD testing and the short- and long-term risks of HDM-ASCT. Recognising that prospective data remains limited, we suggest that HDM-ASCT not be considered mandatory for eligible newly diagnosed patients who are treated with highly efficacious regimens and achieve deep responses, but rather be held in reserve without early exposure to the clinical and genomic toxicity inherent to this approach. © 2020 British Society for Haematology and John Wiley & Sons Ltd
Keywords: multiple myeloma; autologous stem cell transplant; high-dose melphalan
Journal Title: British Journal of Haematology
Volume: 191
Issue: 5
ISSN: 0007-1048
Publisher: John Wiley & Sons  
Date Published: 2020-12-01
Start Page: 692
End Page: 703
Language: English
DOI: 10.1111/bjh.16764
PUBMED: 32501533
PROVIDER: scopus
PMCID: PMC8505046
DOI/URL:
Notes: Review -- Export Date: 4 January 2021 -- Source: Scopus
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  1. Carl Ola Landgren
    336 Landgren