Autologous stem cell transplantation in the management of multiple myeloma

Autologous stem cell transplantation has been shown to improve the survival in patients with multiple myeloma. Seven randomized clinical trials have been reported demonstrating the superiority of stem cell transplantation in inducing disease responses, increasing complete remissions, and prolonging event-free survival (Table 10.1). Three trials demonstrated significant prolongation of median survival in newly diagnosed patients [1]. The largest of these trials enrolled 401 patients and, compared with standard therapy, prolonged median survival by almost 1 year [2]. The available therapies in the era of these trials, however, did not include the novel agents, thalidomide, lenalidomide, and bortezomib, and some have questioned the rationale for stem cell transplantation with the advent of novel agents.