The role of stem cell transplantation in the modern management of multiple myeloma

Purpose of review Autologous stem cell transplantation (ASCT) has long been a cornerstone in the treatment of eligible patients with newly diagnosed multiple myeloma (NDMM). In this review, we analyze the evolving role of ASCT in the contemporary period. Recent findings With the growing integration of modern induction regimens and advanced immunotherapies such as chimeric antigen receptor T-cell (CAR-T) therapies and bispecific antibodies (BsAbs), the traditional paradigm of multiple myeloma treatment is being increasingly challenged. These novel treatments, which have demonstrated unique response rates and unprecedented minimal residual disease (MRD) rates, have raised the question about the role, timing, and necessity of ASCT. Summary ASCT has been standard of care in the treatment of NDMM for transplant-eligible patients for over three decades. With the advent of modern induction regimens and immunotherapies, treatment paradigms are evolving rapidly, challenging the current role, timing, and necessity of ASCT. This review explores the contemporary role of ASCT in NDMM. Despite the promise of immunotherapy, the current evidence continues to support ASCT as a consolidative therapy that remains highly effective, accessible, and cost-efficient, particularly when integrated with modern therapeutics and MRD-driven algorithms.