Fresh (Non-cryopreserved) autologous stem cell transplantation in multiple myeloma: Faster engraftment and reduced hospitalization

BACKGROUND: Cryopreserved autologous hematopoietic stem cell transplantation using dimethyl sulfoxide is standard in multiple myeloma but it is associated with infusion-related toxicity and high cost. This study aimed to evaluate the feasibility, safety, and outcomes of dimethyl sulfoxide-free, fresh (non-cryopreserved) autologous stem cell transplantation in multiple myeloma patients at a single tertiary center. METHODS: A retrospective analysis was conducted in 40 multiple myeloma patients who underwent transplantation using freshly collected, non-cryopreserved peripheral blood stem cells between 2023 and 2025 at Dokuz Eylül University Hospital. Peripheral blood stem cells were infused within 72 h after collection without cryopreservation. Engraftment kinetics, toxicity, and length of hospital stay were assessed descriptively. RESULTS: All patients achieved hematopoietic engraftment (100%). Median neutrophil and platelet engraftment occurred at nine (range: 6-14) and 11 days (range: 7-16), respectively and the median hospitalization was 13 days. No infusion-related adverse events or grade 3-4 mucositis were observed. This approach eliminated dimethyl sulfoxide-related toxicity, reduced cryopreservation-related resource utilization and associated procedural costs. CONCLUSION: Fresh, dimethyl sulfoxide-free autologous stem cell transplantation in multiple myeloma is a safe, effective, and cost-efficient alternative to cryopreserved transplantation. It provides rapid engraftment, reduced hospitalization, and improved patient comfort, representing a practical model for modern transplant centers.