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

Future Directions

The IFM 2009 trial showed that VRD induction followed by ASCT and lenalidomide maintenance resulted in superior levels of MRD negativity to 10−6 in the ASCT arm (30% v 20%; P = .02).[5] Given that MRD negativity is a surrogate marker for survival, whether MRD negativity achieved with induction therapy can eliminate the need for ASCT and whether other regimens, such as quadruplet induction/maintenance regimens consisting of immunomodulatory agent, proteasomeinhibitor, andmonoclonal antibodies, can achieve superior MRD negativity compared with ASCT remains to be determined by prospective trials. Furthermore, the incorporation of chimeric antigen receptor T-cell and bispecific T-cell engager antibodies in combination with ASCT is also being evaluated in prospective trials (Figure 1; Table 3).

Figure 1.

Autologous stem-cell transplantation (ASCT) in relation to chimeric antigen receptor T cell (CAR-T) and bispecific T-cell engager (BiTE) for multiple myeloma (MM). Several plasma cell antigens are currently in the preclinical and clinical phases of development as therapeutic targets for CAR-T and BiTE antibodies. BCMA, B-cell maturation antigen.

In conclusion, ASCT should remain an integral part of the treatment of patients with both newly diagnosed and relapsed MM. The advent of novel agents incorporated into induction, conditioning, consolidation, and maintenance regimens in relation to ASCT have deepened the hematologic responses and conferred both PFS and OS benefits, even in patients with high-risk disease. The role and timing of ASCT will continue to have to be defined, as nextgeneration novel therapies continue to be developed and as our ability to detect MRD continues to improve.