Autologous Stem-Cell Transplantation for Multiple Myeloma in the Era of Novel Therapies

Ricardo D. Parrondo, MD; Sikander Ailawadhi, MD; Taimur Sher, MD; Asher A. Chanan-Khan, MD; Vivek Roy, MD


J Oncol Pract. 2020;16(2):56-66. 

In This Article

Salvage ASCT

The majority of patients will experience relapsed MM, despite consolidation and/or maintenance therapy after their first ASCT. A second ASCT as a salvage option in relapsed MM is a validated tool in the arsenal of MM treatment. A prospective phase III RCT of 297 patients compared ASCT with cyclophosphamide for relapsed MM, and after a median follow-up of 52 months, median time to progression was significantly longer in the salvage ASCT group than in the cyclophosphamide group (19 v 11 months; HR, 0.36; P < .0001) as was median OS (67 v 52 months; HR, 0.56; P = .022).[51] Patients who experience relapse within 18 months after a first ASCT have a dismal prognosis (median OS<6 months) compared with patients who experience relapse more than 18 months (median OS, nearly 3 years) after a first ASCT.[52] As such, it is currently recommended that a second ASCT as salvage therapy be offered only to patients whose disease was controlled by the first ASCT for 18 months or longer. Of interest, a retrospective study of 88 patients who had undergone a third ASCT after a prior second salvage ASCT for relapsed disease found that patients who achieved a relapse-free interval of more than 18 months between the second and third ASCT had a median OS of 27 months.[53]