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.
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Reviewed on January 17, 2017 for clinical relevance.