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The Role of Pre-Transplant Induction Regimens and Autologous Stem Cell Transplantation in the Era of Novel Targeted Agents

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Abstract

Outcome of patients with multiple myeloma (MM) has greatly improved with the use of autologous stem cell transplantation (ASCT) and new agents, such as immunomodulatory drugs (thalidomide and lenalidomide) and proteasome inhibitors (bortezomib). When compared to conventional chemotherapy, high-dose melphalan with ASCT significantly improved response rates and progression-free survival, while overall survival benefit was not consistent across all trials. ASCT is considered the standard treatment for patients who are younger than 65 years and who do not have limiting comorbidities. New, effective agents have been introduced as part of induction, consolidation and maintenance treatments within ASCT and in combinations with chemotherapy for patients not eligible for ASCT. The remarkable results obtained with these regimens are questioning the role of ASCT for newly diagnosed MM patients. This article aims to delineate the role of ASCT in the era of novel agents based on the results of recent clinical trials.

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Acknowledgments

The authors thank the editorial assistant Giorgio Schirripa and Dr. Francesca Donato for the assistance in collecting data and revising the final manuscript.

Authorship

FG, FC, and AP collected and analyzed the data, and wrote the manuscript.

Disclosures

No funding was received for the preparation of this manuscript.

Conflict-of-interest disclosures: FG has received honoraria from Celgene and Janssen-Cilag, and served on the advisory committee for Celgene and Byotest; FC has received honoraria from Celgene, Janssen-Cilag, Onyx, and has served on the advisory committee of Celgene; AP has received honoraria from Celgene, Janssen-Cilag, Bristol-Myers Squibb, Millennium, Merck, Onyx, and has served on the advisory boards of Celgene and Janssen-Cilag.

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  1. Myeloma Unit, Divisione di Ematologia dell’Università di Torino, Azienda Ospedaliera S. Giovanni Battista, Via Genova 3, 10126, Torino, Italy

    Francesca Gay, Federica Cavallo & Antonio Palumbo

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  1. Francesca Gay
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  2. Federica Cavallo
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  3. Antonio Palumbo
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Correspondence to Antonio Palumbo.

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Gay, F., Cavallo, F. & Palumbo, A. The Role of Pre-Transplant Induction Regimens and Autologous Stem Cell Transplantation in the Era of Novel Targeted Agents. Drugs 75, 367–375 (2015). https://doi.org/10.1007/s40265-015-0367-0

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