Newly diagnosed multiple myeloma in transplant-eligible patients

Multiple myeloma (MM) is characterized by clonal proliferation of malignant plasma cells in the bone marrow. An estimated 30,280 new cases of MM will be diagnosed in the USA in 2017 (CA Cancer J Clin67(1):7-30, 2017). The introduction of proteasome inhibitors (PIs) and immunomodulators (IMiDs) in conjunction with autologous stem cell transplantation (ASCT) has markedly improved the overall survival (OS) in MM, with the survival gap between MM patients and matched controls decreasing in the last decade (Leukemia 2017). The incorporation of ASCT into the frontline therapy of transplant-eligible (TE) patients in the late 1990s had shown a remarkable improvement in survival in younger myeloma patients between 2001 and 2005 (Eur J Cancer46(1):160-169, 2010). Currently, PI and/or IMiD-based combinations are the standard of care for pretransplant induction therapy in TE newly diagnosed MM patients (J Natl Compr Cancer Netw 15(2):230-269, 2017). Furthermore, the addition of long-term maintenance therapy after ASCT has also led to improved progression-free and overall survival (J Clin Oncol34(Suppl 15):8001, 2016). Hence, there has been a paradigm shift in the management of newly diagnosed MM, leading to the achievement of a deep and durable disease control and improved survival, with the current median OS being greater than 6 years (Leukemia 28(5):1122-1128, 2014).