Is double autologous transplantation in multiple myeloma superior in the age of new agents?

Jean-Luc Harousseau, MD, from the University of Nantes, Nantes, France, discusses the use of double autologous transplantation in multiple myeloma (MM) at the 2017 annual meeting of the European Society for Blood and Marrow Transplantation (EBMT) in Marseille, France. Prof. Harousseau explains that his group first demonstrated that double transplantation gave superior event-free survival and overall survival compared to single transplantation. However, he explains that other studies were not as positive. With the introduction of new agents, it was thought that double transplantations would no longer be needed. Prof. Harousseau compares two randomized trials which looked at double transplantation. One of these trials showed that double transplantation is still superior to single transplantation in the era of novel therapy for patients with high risk cytogenetics. However, the other did not find a difference in progression free survival or overall survival. He concludes that we do not know the place for double autologous transplantation, and that it may only be beneficial for patients with high cytogenetic risk. He believes that in the future it may be important to look at minimal residual disease (MRD) after the first autologous transplantation and use it as an indication to determine if additional consolidation therapy, including double autologous transplantation, should be carried out.

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