In multiple myeloma (MM), the use of high-dose chemotherapy with autologous stem cell transplantation (ASCT) led to incremental advances in patient management in the 1990s. The clinical results for patients dramatically improved further in the 2000s with the introduction of immunomodulatory drugs and proteasome inhibitors. In the 'modern' era for MM treatment, transplant trials strongly support the use of upfront ASCT in the context of novel agents, and until proven otherwise, the old ASCT remains the standard of care for eligible patients. Nevertheless, some issues remain unresolved and this editorial aims to highlight the concerns to be addressed in the future.
Keywords: autologous stem cell transplantation; high-dose melphalan; immunomodulatory drugs; multiple myeloma; new drugs; proteasome inhibitors.