“No” for the allogeneic stem cell transplantation in young patients diagnosed with multiple myeloma

Abstract

Autologous stem cell transplantation (ASCT) is considered the standard of care in younger patients diagnosed with multiple myeloma (MM). However, despite an increase in the number of sustained responses, MM remains an incu­rable disease. Allogeneic stem cell transplantation (alloSCT) may have a curative potential resulting from induction of graft-versus-myeloma effect, but several factors limit its implementation in routine clinical practice. Myeloablative conditioning is associated with high (> 30%) treatment-related mortality (TRM), primarily due to graft-versus-host disease and infections, while the use of reduced-intensity conditioning increases the risk of relapse and disease progression, and also results in an unacceptably high TRM (21–23%). Auto/allotransplantation is not superior to tandem ASCT in terms of progression-free survival and overall survival, even in high-risk MM patients. The majority of younger patients may achieve sustained remissions after novel agents and ASCT, and nowadays alloSCT should be considered mainly in the context of clinical trials.