Real World Predictors, Timing, and Outcomes of Autologous Stem Cell Transplantation in Patients with Multiple Myeloma

Background—Autologous stem cell transplant (ASCT) is integral to the treatment of multiple myeloma (MM), although its absolute necessity in first remission has been recently questioned. We report real-world factors that influence clinical decision-making and outcomes from ASCT in 733 patients with MM. Results—Similar to recent prospective data, we found a significant progression-free survival (PFS) benefit with early versus deferred ASCT (median PFS of 5.1 years versus 2.6 years, p < 0.001); however, there was no significant difference in overall survival (median OS of 8.3 years and 8.6 years, p = 0.21). Patient preference, age, marital status, body mass index, and comorbidities influence ASCT timing. Conclusion—These findings highlight the emerging role of an individualized, shared decision-making model regarding the timing of ASCT between patients and physicians with the myriad of treatment options available in the contemporary era.