Usmani on Indications and Timing of Autologous Transplant in Myeloma

Saad Z. Usmani, MD, MBA, FACP, FASCO, chief of the myeloma service at Memorial Sloan Kettering Cancer Center, discusses the specific patient subgroups for whom autologous transplant remains the best course of action for.

He then continues the conversation by discussing the current best practices for determining the optimal time for transplant in these patients.

Transcription:

0:09 | For high-risk patients specifically, I think incorporating autologous stem cell transplants is very important. The way that we define high-risk is any active patient [with myeloma] who is at the risk of relapsing early and dying from disease within the first 3 to 5 years of diagnosis. For those patients, we do not get many opportunities to control the disease, so this is where I think autologous [stem cell transplants] become important. For some of the standard-risk patients who have low disease burden, sometimes it becomes a discussion around quality of life and whether they want to prioritize their lifestyle right now compared with getting into an autologous stem cell transplant. For high-risk patients, it is clear from the available data that it needs to be part of the treatment schema.

1:10 | I think the overarching theme for us is we want to get patients into very deep responses during the first year of diagnosis and try to maintain patients in that deep response. This is where I think the role of autologous stem cell transplants comes into play. We do not have any clinical trials right now that have shown us that if we get to, say [minimal residual disease]-negative status, that we can hold everything. We just don't have that randomized data yet, but I think that kind of data is being generated and that will help inform us. The overarching theme is to get patients the best depth of response during that first year of diagnosis, and [autologous transplants] help both standard-risk and high-risk patients in that regard.