Multiple Myeloma: The Role of Autologous Stem Cell Transplantation in the Era of Immunotherapy

Abstract

Upfront high-dose therapy with melphalan (HDM) followed by autologous stem cell transplantation (ASCT) has established itself as a core treatment for newly diagnosed multiple myeloma (NDMM) patients in the past 30 years. Induction therapy, HDM-ASCT, and subsequent consolidation and maintenance therapy comprise the current fundamental framework for MM treatment. The introduction of anti-CD38 monoclonal antibodies such as daratumumab and isatuximab has changed the treatment paradigm for transplant-eligible NDMM patients in that quadruplets have become the new standard induction therapy. The treatment landscape of MM is undergoing a transformative shift with the introduction of potent new immunotherapies, such as chimeric antigen receptor (CAR)-T cells and bispecific antibodies (BsAbs), which are currently used in the relapsed/refractory setting (RRMM) and are already being tested in the NDMM. This review will focus on the incorporation of immunotherapy in the treatment scenario of NDMM patients eligible for ASCT.

Advancements in Biomarkers and Molecular Targets in Hematological Neoplasias

“…In the context of molecular biomarkers, Bergantim et al [ 6 ] demonstrated the feasibility of isolating and characterizing extracellular vesicles (EVs) obtained from multiple myeloma (MM) patients’ bone marrow and peripheral blood samples at diagnosis and remission. MM is an incurable disease and the third most common hematological neoplasia, accounting for 10% of newly diagnosed hematological neoplasia [ 7 ]. This neoplasia arises from the malignant transformation of post-germinal center plasma cells [ 8 ].…”