How does stem cell transplantation affect other treatment decisions in patients with multiple myeloma?

Updated: Jul 11, 2019
  • Author: Sara J Grethlein, MD; Chief Editor: Emmanuel C Besa, MD  more...
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In general, the first decision made in the management of patients with myeloma who require systemic therapy is whether stem cell transplantation is part of the strategy. Considerations are as follows:

  • Alkylator and nitrosourea therapy is usually deferred or reduced in patients who may require autologous stem cell collection, to avoid injury to the stem cells

  • A single autologous stem cell transplant has been associated with superior event-free survival compared with chemotherapy and is considered the preferred approach [1]

  • As newer agents (bortezomib, thalidomide, and lenalidomide) are studied, the role of transplantation will continue to evolve

  • Induction chemotherapy followed by autologous stem cell support is widely used as treatment in patients with multiple myeloma; however, there is growing evidence that only the subset of patients who achieve complete remission (CR) actually benefit from this approach [2]

  • Complete remission is defined as negative serum and urine immunofixation, disappearance of soft-tissue plasmacytomas, and < 5% plasma cells in bone marrow [3]

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