Visual abstract | Autologous stem cell transplantation in newly diagnosed multiple myeloma: Real-world results

As a first-line therapy, autologous stem cell transplantation (ASCT) remains an important option for patients with multiple myeloma (MM) who are eligible for transplant. With the introduction of novel drugs and advancements in treatments, there are now different approaches taken before and after ASCT, including different combinations of induction, consolidation, and maintenance therapy.

The Multiple Myeloma Hub is pleased to present a visual abstract on a real-world retrospective cohort study by Côté J, et al.¹ evaluating the outcomes of ASCT performed as first-line therapy in patients with newly diagnosed MM. The different regimens used for the transplant treatment sequence (induction, consolidation, maintenance) and their contribution to clinical outcomes were evaluated. The study found that:

• The median overall survival currently exceeds 10 years, except in high-risk patients, with the integration of bortezomib, lenalidomide, and maintenance therapy into the first-line treatment sequence in transplant-eligible patients.
• Patients who received a second induction regimen had significantly inferior outcomes. However, when maintenance was used, results were comparable regardless of the number of induction regimens administered.
• Overall, receiving maintenance therapy was significantly associated with better survival outcomes. This advantage was still significant when filtered by those patients who were treated specifically with lenalidomide +/- steroids.
• In high-risk patients, there was a significant progression-free survival benefit for tandem ASCT, but median overall survival was better with a single ASCT. The benefit of a tandem over single ASCT was not statistically significant when maintenance was given.
• High-risk patients who received maintenance therapy showed longer median progression-free survival and overall survival regardless of number of induction regimens.
• None of the analyzed treatment strategies overcame the negative impact of high-risk cytogenetics over survival outcomes, so further research is needed to find an optimized therapeutic approach for these patients.