High dose Melphalan supported by autologous transplantation is the standard of care for eligible patients with newly diagnosed multiple myeloma for more than 25 years. Several randomized clinical trials have recently reaffirmed the strong position of transplant in the era of proteasome inhibitors and immunomodulatory drugs combinations, demonstrating a significant reduction of progression or death in comparison with strategies without transplant. Immunotherapy is currently changing the paradigm of multiple myeloma management and daratumumab is the first-in-class human monoclonal antibody targeting CD38 approved in the setting of newly diagnosed multiple myeloma. Quadruplets become the new standard in the transplantation programs, but outcomes remain heterogeneous with various response depth and duration. Otherwise, the development of sensitive and specific tools for disease prognostication allows to consider adaptive strategy to a dynamic risk. I discuss in this review the different available options for the treatment of transplant-eligible multiple myeloma patients in frontline setting.
Keyphrases
- multiple myeloma
- newly diagnosed
- high dose
- monoclonal antibody
- healthcare
- cell therapy
- end stage renal disease
- palliative care
- endothelial cells
- public health
- ejection fraction
- type diabetes
- optical coherence tomography
- bone marrow
- clinical trial
- stem cells
- skeletal muscle
- stem cell transplantation
- chronic kidney disease
- metabolic syndrome
- adipose tissue
- quality improvement
- cancer therapy
- pluripotent stem cells
- pain management
- replacement therapy