Autologous transplantation for multiple myeloma.

Until now high-dose therapy (HDT) supported by autologous stem cell transplantation (ASCT) has been considered the standard of care for frontline therapy of multiple myeloma (MM) in younger patients with normal renal function, and MM is currently the first indication of ASCT. However, the introduction of the novel agents thalidomide, bortezomib and lenalidomide is changing the scenario in two ways. First, these agents can be added to HDT either before or after ASCT with the objectives of increasing the complete remission (CR) rate and of prolonging first remission duration. Secondly, the use of novel agents as frontline therapy in combination with either dexamethasone or alkylating agents yields CR rates and progression-free survival (PFS) rates that are comparable with those achieved with HDT. Therefore, the role of ASCT is again a matter of debate: should it be used upfront or only as salvage treatment at progression in patients initially treated with novel agents?