Is there still a place for autologous salvage transplantation in relapsed/refractory multiple myeloma in the era of novel therapies?

• DOI: 10.1007/s00277-025-06262-9
• Publication Date: 2025-02-26T02:01:42Z
• Authors: Simone Karp; Karolin Trautmann...; Paul Warncke; Dominik Zolnowski; Christoph Röllig; Marcel Pannach; Jessica Zinn; Frank Kroschinsky; Anke Morgner; Malte von Bonin; Annette Hänel; Regina Herbst; Stephan Fricke; Martin Bornhäuser; Mathias Hänel; Raphael Teipel
• Keywords: Salvage therapy; Hematology

Abstract For patients (pts) with relapsed or refractory multiple myeloma (RRMM) after previous autologous hematopoietic cell transplantation (AHCT), novel agents, cellular and immunotherapies are increasingly available. Options for second-line treatment mostly include triplet regimens based on proteasome inhibitors, immunomodulatory drugs anti-CD38 monoclonal antibodies since recently also CAR T cells. The importance of salvage (retransplantation, Re-AHCT) has significantly decreased in recent years due to the availability many new options. Therefore, we performed a retrospective analysis 171 pts cases RRMM who received Re-AHCT between 2002 2021. With median follow-up 74.7 months, 5-year rates progression-free survival (PFS) overall (OS) were 18% (median 20.6 months) 57% 65.0 months), respectively, 100-day mortality rate was 4%. Multivariate identified R-ISS stage duration response (DoR) as independent prognostic factors PFS OS. While revealed high-risk population (R-ISS II/III, DoR ≤ 24 associated worse (HR 2.728) OS 3.129), low-risk group I, > achieved 45.0 months 80.2 respectively. could remain an option such prognostically favorable even era therapies especially when more potent modalities not