The Role of ASCT in Frontline Myeloma: Comparative Risks and Benefits with Other Standard Treatment Approaches

EP: 1.Treatment Approaches and Goals: Transplant-Eligible vs. Transplant-Ineligible Patients

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EP: 2.The Role of ASCT in Frontline Myeloma: Comparative Risks and Benefits with Other Standard Treatment Approaches

This segment addresses the comparative benefits and risks of incorporating autologous stem cell transplant in frontline multiple myeloma management, particularly in the era of quadruple versus triplet therapy regimens. The discussion features expert perspectives on transplantation's continued role despite advances in drug therapy combinations. Historical clinical studies consistently demonstrate that transplantation provides significant improvements in response rates and progression-free survival, even when combined with three-drug regimens, establishing its continued relevance in modern treatment protocols.

The panel addresses emerging questions about whether transplantation remains necessary with the introduction of four-drug regimens, which have shown impressive minimal residual disease (MRD) negative responses and exceptional progression-free survival rates. However, current clinical trial data supporting these excellent outcomes still incorporate transplantation as part of the treatment protocol. The experts emphasize that while quadruple therapy shows promise, there isn't yet sufficient clinical trial evidence to support eliminating transplantation from standard care protocols.

For patients hesitant about immediate transplantation, the experts recommend stem cell collection and storage as a viable option, preserving future treatment possibilities. The discussion also covers the challenges of deferred transplantation, noting that delayed transplant often becomes "never" as patients' perspectives change over time. The panel concludes that the current evidence strongly supports maintaining transplantation as part of the standard treatment approach, as it continues to provide the best progression-free survival outcomes for eligible multiple myeloma patients.