Multiple Myeloma: Future Directions in Autologous Transplantation and Novel Agents

Autologous hematopoietic cell transplantation (AHCT) in the 1990s and the advent of “novel” therapy, such as immune modulators and proteasome inhibitors, in the 2000s have led to impressive gains in the treatment of multiple myeloma (MM) [1,2]. In the prenovel drug era, the therapy paradigm composed of induction followed by planned AHCT in eligible patients, denoted as “upfront” or early AHCT, aimed at achieving a deeper disease response and longer survival. With modern induction therapies incorporating novel drugs, the timing and need for AHCT is increasingly debated because an additional survival benefit for early AHCT has not been established with modern induction regimens.