title: Recommend upfront consolidation with high-dose melphalan and autologous stem cell support.
abstract: The overall goal of treatment for multiple myeloma (MM) is to prolong survival for as long as possible with the minimal treatment burden for each patient. Consolidation with upfront high-dose melphalan and autologous hematopoietic stem cell transplantation (ASCT) can prolong progression-free and overall survival by deepening response. It thereby can improve quality of life by allowing patients to have a time on maintenance therapy along with infrequent office visits, making it cost-effective in many situations. The impact of minimal residual disease (MRD) negativity is important, but further studies are needed to quantify the pharmacoeconomic and quality-of-life differences between early and delayed transplant strategies. Therefore, with the currently available evidence, upfront ASCT is standard of care regardless of MRD status.
authors.affiliation: Adult Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center, New York, NY.
authors.forename: Gunjan L
authors.initials: GL
authors.lastname: Shah
authors.affiliation: Adult Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center, New York, NY. Electronic address: giralts@mskcc.org.
authors.forename: Sergio A
authors.initials: SA
authors.lastname: Giralt
mesh_terms: D003131:Combined Modality Therapy; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D008297:Male; D008558:Melphalan / Q000627:therapeutic use*; D008875:Middle Aged; D009101:Multiple Myeloma / Q000401:mortality / Q000523:psychology / Q000628:therapy*; D011788:Quality of Life; D014182:Transplantation, Autologous
chemical_list: D008558:Melphalan
keywords: Autologous stem cell transplant; Minimal residual disease; Multiple myeloma