Balancing Timing of ASCT: Insights on Delayed Transplantation and Long-Term Treatment Outcomes

EP: 1.Treatment Approaches and Goals: Transplant-Eligible vs. Transplant-Ineligible Patients

EP: 2.The Role of ASCT in Frontline Myeloma: Comparative Risks and Benefits with Other Standard Treatment Approaches

EP: 3.Evaluating First-Line Treatment Options: Quadruplet vs Triplet Regimens and NCCN Guidelines

EP: 4.The Role of MRD Status in Post-ASCT Treatment Decisions and Clinical Integration

EP: 5.Tailoring Maintenance Therapy by Patient Risk: Lenalidomide Alone vs Combination Approaches

Now Viewing

EP: 6.Balancing Timing of ASCT: Insights on Delayed Transplantation and Long-Term Treatment Outcomes

This segment addresses the considerations for delaying autologous transplant in certain multiple myeloma patients and compares long-term outcomes between early versus deferred transplant approaches. The discussion emphasizes caution regarding transplant deferral, noting the substantial real-world evidence supporting transplant benefits and the need for concrete medical reasons before considering delay. Quality of life issues, borderline organ function (pulmonary or cardiac), and frailty concerns represent valid reasons for transplant deferral, particularly when immediate transplant might render a patient ineligible for future procedures.

The concept of deferring transplant based on deep responses to induction therapy generates significant debate among experts. While some suggest that excellent responses to quadruple induction therapy might justify transplant delay with stem cell collection, the panel expresses skepticism about this approach becoming standard care. The discussion emphasizes that achieving deep responses should complement rather than replace transplant, as combination approaches typically yield superior outcomes for fit patients committed to their treatment journey.

Long-term outcome data strongly favors early transplant over deferred approaches, with clear progression-free survival benefits. The panel notes that 15% to 20% of patients may achieve functional cure with intensive therapy including transplant, representing a plateau effect at 10 to 15 years that doesn’t occur without consolidation therapy. Additionally, the discussion highlights the dynamic nature of transplant eligibility, noting that patients initially deemed ineligible due to disease-related complications may become candidates as their condition improves with initial therapy, emphasizing the importance of regular reassessment.