What have we learned about the timing of transplant for newly diagnosed MM patients?

FAQ Library published on December 18, 2014
Download Transcript Download Audio
Sergio A. Giralt, MD, FACP
Melvin Berlin Family Chair in Myeloma Research
Professor of Medicine
Weill Cornell Medical College
Chief Attending Physician
Adult Bone Marrow Transplant Service
Memorial Sloan Kettering Cancer Center
New York, New York

Hello and thank you for visiting Managing Myeloma. My name is Sergio Giralt. I am a professor of medicine at Weill Cornell Medical College and chief of the Adult BMT Service at Memorial Sloan-Kettering Cancer Center. I frequently get asked "What have we learned about the timing of transplant for newly diagnosed multiple myeloma patients?"

In 2014 we still consider that high-dose therapy consolidation with high-dose melphalan and autologous transplant should be the standard of care for all symptomatic myeloma patients who have undergone induction therapy. However, we recognize, particularly in low-risk patients who achieve major remissions to current modern induction therapy with an IMiD, a proteasome inhibitor, and steroids, that opting out of front-line transplantation is a reasonable choice and that these patients can be collected and be transplanted at the time of disease progression. However, we only have retrospective data. The retrospective data suggests that although progression-free survival may be superior for upfront transplantation, overall survival is similar for patients who opt out of front-line transplantation and then proceed to transplantation at the time of disease relapse. We consider that it is important that patients be educated that only the results of the DETERMINATION trial will show us whether front-line versus transplantation delayed until the time of first relapse have similar outcomes. Until we have the results of those trials, I strongly encourage patients to get a transplant consult and talk to their physicians about timing of transplantation in their situation.

Thank you very much for visiting Managing Myeloma.

Reviewed on January 17, 2017 for clinical relevance.

Last modified: February 8, 2017
Related Items by Author
Should I wait for the development of CRAB prior to initiating therapy in multiple myeloma patients?
Sergio A. Giralt, MD, FACP
FAQ Library published on October 11, 2016
What are the new NCCN/IMWG recommended baseline workup tests for multiple myeloma?
Sergio A. Giralt, MD, FACP
FAQ Library published on August 3, 2016
Will new MM diagnostic criteria cause confusion in risk stratifying smoldering and active myeloma?
Sergio A. Giralt, MD, FACP
FAQ Library published on June 7, 2016
How do I manage the side effects of stem cell transplantation?
Sergio A. Giralt, MD, FACP
FAQ Library published on January 9, 2013 in Stem Cell Transplant, Comorbidities/SEs
Which patients do you consider for delayed transplantation?
Sergio A. Giralt, MD, FACP
FAQ Library published on January 9, 2013 in Stem Cell Transplant
What are the common side effects of melphalan?
Sergio A. Giralt, MD, FACP
FAQ Library published on August 30, 2012 in Comorbidities/SEs
What are the side effects of bendamustine?
Sergio A. Giralt, MD, FACP
FAQ Library published on August 2, 2012 in Comorbidities/SEs
What are the most common side effects of lenalidomide therapy?
Sergio A. Giralt, MD, FACP
FAQ Library published on July 26, 2012 in Comorbidities/SEs, Nurses & Pharmacists
How do I address concerns for patients who “refuse” stem cell transplantation?
Sergio A. Giralt, MD, FACP
FAQ Library published on September 26, 2011 in Stem Cell Transplant, Patient Communication
Is there a subset of patients that would benefit from delayed SCT?
Sergio A. Giralt, MD, FACP
FAQ Library published on September 8, 2011 in Stem Cell Transplant