Hematopoietic Cell Transplantation in Multiple Myeloma

Multiple myeloma is a malignant plasma cell disorder originating from the bone marrow that may also affect the bones, kidneys, and the immune system. Multiple myeloma is still considered incurable, and the goal of treatment is to achieve a deep and durable remission. High-dose chemotherapy and autologous hematopoietic cell transplant (auto-HCT) are considered an integral part of the upfront treatment in newly diagnosed patients and can be safely performed even in older patients and those with multiple comorbidities. The induction regimens administered before auto-HCT has evolved from conventional chemotherapy to the current regimens consisting of proteasome inhibitors, immunomodulatory drugs, corticosteroids, and monoclonal antibodies. The use of consolidation and maintenance therapies posttransplant has further improved the depth and the durability of response. In this chapter, we will discuss the benefit of auto-HCT compared to chemotherapy alone, the ideal timing of auto-HCT, single versus tandem transplant, its benefit in the relapsed setting, and the role of allogeneic hematopoietic cell transplant.