IMW 2021 | The future role of transplantation in myeloma

This is a challenging question. And today, 2021, and transplant continues being the standard of care. Even after novel agents based combination, and we can talk about proteasome inhibitors, immunomodulatory drugs, and even anti-CD38 monoclonal antibodies. And transplant is complimentary because high-dose melphalan that the disease is what it means, the autologous stem cell transplantation, is able to upgrade the quality of the response.

However, it’s true that there are some clinical trials, in which to transplant resulted into a similar overall survival to non-transplant that like this is the case for a French study. These means that maybe we can incorporate the patient preferences when we have a newly diagnosed myeloma patient in front of us. Definitely today, it continues being a standard of care, but this is going to be challenged in the near future.

From my personal perspective, I think that we are going to incorporate risk factors as well as the minimal residual disease status after an optimal induction and maybe patients with our RISS-1 as well as minimal residual disease negative after an optimal induction and maybe theses patients should not need autologous stem cell transplantation. Definitely this is under investigation in Phase III clinical trials that are ongoing, and we will see what happens, but you have to know that the BCMA CAR-Ts are also going to maybe to challenge autologous system stem cell transplantation in Phase III clinical studies.

So, we will see what happens. Today, we continue offering transplant to our patients, and in the future, I think that we will not be able to offer transplant to all patients. Maybe only to those with high-risk cytogenetic abnormalities, we will see what happens.