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Autologous hematopoietic cell transplantation in multiple myeloma

S Vincent Rajkumar, MD
Section Editors
Robert S Negrin, MD
Robert A Kyle, MD
Deputy Editor
Rebecca F Connor, MD


Autologous hematopoietic cell transplantation (HCT), performed either at the time of initial diagnosis or at relapse, is considered the standard of care for younger patients (less than 70 years of age) with newly diagnosed multiple myeloma (MM) (algorithm 1). While neither chemotherapy nor autologous HCT produces a cure, event-free survival and overall survival are prolonged following autologous HCT when compared with treatment with conventional chemotherapy alone.

As new chemotherapeutic agents (eg, bortezomib, thalidomide, lenalidomide) are incorporated into the initial treatment of MM, survival with chemotherapy alone is improving. Whether the use of these newer agents, alone or in combination, will delay or eliminate the need for HCT in patients with MM is not known at this time. In addition, survival with HCT is improving for certain populations with the incorporation of double (tandem) autologous HCT.

In contrast, allogeneic HCT has the potential for cure, although at a cost of increased treatment-related mortality. The use of allogeneic HCT for MM is discussed in detail separately. (See "Allogeneic hematopoietic cell transplantation in multiple myeloma".)

Practical issues regarding the use of autologous HCT in myeloma are presented here. Eligibility criteria for HCT, a comparison of HCT with other treatment strategies, and the initial chemotherapy choices for patients with myeloma are discussed separately. (See "Overview of the management of multiple myeloma" and "Selection of initial chemotherapy for symptomatic multiple myeloma".)

The term "hematopoietic cell transplantation" (HCT) will be used throughout this review as a general term to cover transplantation of progenitor (stem) cells from any source (eg, bone marrow, peripheral blood, cord blood). Otherwise, the source of such cells will be specified (eg, autologous peripheral blood progenitor cell transplantation). (See "Sources of hematopoietic stem cells".)

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Literature review current through: Nov 2017. | This topic last updated: Aug 08, 2017.
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