Tandem autologous hematopoietic stem cell transplantation in multiple myeloma: A historical perspective and current challenges

TL;DR

This paper reviews the role of tandem autologous stem cell transplants in treating multiple myeloma, comparing it with other treatments and discussing its challenges.

Contribution

The paper critically evaluates the efficacy and challenges of tandem autologous hematopoietic stem cell transplantation in the context of emerging therapies for multiple myeloma.

Findings

Tandem autologous HSCT improves progression-free and overall survival in high-risk multiple myeloma.

Allogeneic HSCT offers potential cure but is limited by transplant-related mortality and GVHD.

Emerging therapies challenge the role of tandem autologous HSCT in MM treatment.

Abstract

Multiple myeloma (MM) is a heterogeneous and relapse-prone hematologic malignancy that remains incurable. For newly diagnosed patients aged 70 years or younger, who are eligible for transplantation, autologous hematopoietic stem cell transplantation (auto-HSCT) is the preferred first-line treatment. In patients with high-risk multiple myeloma (HRMM), some studies have demonstrated that tandem auto-HSCT provides notable benefits over single auto-HSCT, particularly in extending progression-free survival (PFS) and overall survival (OS). Although allogeneic hematopoietic stem cell transplantation (allo-HSCT) currently offers the only potential for long-term cure in MM, its application is limited by high transplant-related mortality (TRM) and the risk of graft-versus-host disease (GVHD). In recent years, the emergence of novel therapies, including proteasome inhibitors, immunomodulatory drugs, monoclonal antibodies, and chimeric antigen receptor T-cell (CAR-T) therapy, has posed new challenges to the role of tandem auto-HSCT in MM treatment. This review aims to critically examine the efficacy differences between tandem and single auto-HSCT, and sequential allo-HSCT following auto-HSCT. Furthermore, it will rigorously evaluate the role and challenges of tandem auto-HSCT within the evolving therapeutic landscape.

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