ABSTRACT Therapy‐related myelodysplastic syndrome and acute myeloid leukemia (MDS/AML) are increasingly recognized as late complications of multiple myeloma (MM) treatment and are associated with a dismal prognosis. We report on a patient with highly refractory MM who developed therapy‐related MDS/AML during the course of multiple lines of anti‐myeloma therapy, including proteasome inhibitors, immunomodulatory drugs, anti‐CD38 monoclonal antibodies, and repeated autologous stem cell transplantation. Progressive cytopenias led to bone marrow evaluation and the diagnosis of therapy‐related MDS/AML. Allogeneic hematopoietic cell transplantation (allo‐HCT) was performed primarily for therapy‐related MDS/AML and resulted in durable disease control of both MDS/AML and MM. At the latest follow‐up, approximately 3 years after allo‐HCT, the patient remains in complete remission from therapy‐related MDS/AML and in stringent complete response with sustained minimal residual disease negativity in MM, without any post‐transplant maintenance therapy. Although chimeric antigen receptor T‐cell therapies have demonstrated remarkable efficacy in relapsed and refractory MM, they are not currently regarded as curative. This case highlights that allo‐HCT may still play a clinically meaningful role in selected and complex clinical settings, even in the era of cellular immunotherapy.
Kumamoto et al. (Wed,) studied this question.