Characteristics and outcomes of therapy-related myeloid neoplasms following autologous stem cell transplantation for multiple myeloma

Advances over the last two decades have resulted in a significant improvement in survival of patients with multiple myeloma (MM)—primarily driven by the emergence of immunomodulators (IMiDs), proteasome inhibitors (PI) and monoclonal antibodies. Despite these improvements, high-dose melphalan (HDM)-based autologous stem cell transplantation (SCT) followed by lenalidomide maintenance remains part of standard initial therapy for transplant-eligible patients 1 . The development of therapy-related myeloid neoplasms (t-MN) is an uncommon, but dreadful complication with considerable morbidity and poor survival. While the exposure to melphalan and autologous SCT are known risk factors 2 , 3 , the impact of lenalidomide, in the setting of HDM, is less clear 4 , 5 , 6 , 7 . Autologous SCT followed by lenalidomide maintenance leads to an improved progression-free- and overall survival, making it the de facto standard for eligible patients 5 , 6 . We studied the incidence of t-MN in post-SCT MM patients in the era of novel therapies and studied the impact of lenalidomide exposure on the risk of t-MN post-SCT. We also analyzed factors that may impact outcomes after t-MN diagnosis.