Chapter 5 – Treatment of relapsed multiple myeloma

Contributor: Michel Delforge

4 – Role of allogeneic transplantation

The role of allogeneic SCT (allo-SCT) in MM has become controversial in the era of many therapeutic alternatives. According to international guidelines, allo-SCT should be reserved for younger patients with (ultra-)high risk MM with a first chemosensitive early relapse and a suitable donor [17]. The mortality and morbidity of allo-SCT, even in highly experienced centers, and the many therapeutic alternatives that are becoming available for MM patients, can complicate the decision of allo-SCT. However, one should realize that historical data have repeatedly proven that allo-SCT after multiple lines of treatment or when the disease has become refractory is doomed to fail, and in some patients with an aggressive disease course, achievement of a second stable remission as a bridge to transplant can fail.