Deferring autologous stem cell transplantation for consolidation of minimal residual disease in multiple myeloma

The expanding armamentarium of novel agents used in combination to treat multiple myeloma (MM) can induce clinical responses in most newly diagnosed patients, with encouraging outcomes observed in the relapsed/refractory setting. Highly sensitive techniques to detect minimal residual disease (MRD) are increasingly being employed to gauge the depth of response to modern anti-myeloma therapies and help guide therapeutic decisions. MM patients who have not achieved MRD-negativity, as assessed by one of several available assays, pose a therapeutic dilemma in terms of whether to proceed with high-dose therapy followed by autologous stem cell transplant (ASCT) versus administering additional cycles of chemotherapy. Results of prospective trials designed to directly address this important management decision are ongoing. In this review we highlight evidence that provides support for deferring ASCT in favor of additional anti-myeloma therapy.