# Autologous stem cell transplant (high-dose therapy)

Source: https://onco.cc/technologies/autologous-stem-cell-transplant/  
OnCo record `autologous-stem-cell-transplant` (Technology). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Autologous stem cell transplant collects the patient's own blood-forming stem cells, gives melphalan or another chemotherapy at a dose that would otherwise destroy the marrow, then returns the cells to rebuild it. It is standard consolidation in myeloma and for relapsed lymphoma, though CAR-T has displaced it in early-relapsing large B-cell lymphoma.

## Summary

High-dose melphalan with autologous stem-cell rescue has been the consolidation standard in transplant-eligible myeloma since the 1990s (IFM 90, Attal 1996) and remains so in the quadruplet era (PERSEUS, IFM 2009/DETERMINATION show PFS but not OS benefit over continued triplet therapy). In lymphoma it is the standard salvage consolidation for chemosensitive late relapse (PARMA) and for relapsed Hodgkin lymphoma; CAR-T has displaced it for early-relapsing LBCL. Tandem (two sequential) transplants are used in high-risk neuroblastoma.

## Fields

- Kind: Technology
- Status: standard-of-care
- Last checked: 2026-09-07
- Principle: Peripheral blood stem cells mobilised (G-CSF ± plerixafor), collected by apheresis, cryopreserved; myeloablative conditioning (melphalan 200 mg/m2 in myeloma; BEAM in lymphoma; busulfan-melphalan or carboplatin-etoposide-melphalan in neuroblastoma); reinfusion; engraftment in ~2 weeks.
- Since: 1983
- Strengths: Permits dose intensity impossible otherwise; Decades of outcome data; Widely available
- Limitations: Treatment-related mortality ~1-2% (myeloma) to higher in children; Infertility, second malignancies, prolonged cytopenias; Being challenged by CAR-T and MRD-guided deferral

## Sources

- Wikipedia: https://en.wikipedia.org/wiki/Hematopoietic_stem_cell_transplantation
- Wikipedia: https://en.wikipedia.org/wiki/Hematopoietic_stem_cell_transplantation

## Connected records

- cancers: [Acute promyelocytic leukaemia](https://onco.cc/cancers/apl/), [ALK-negative anaplastic large cell lymphoma](https://onco.cc/cancers/alk-negative-anaplastic-large-cell-lymphoma/), [Atypical teratoid/rhabdoid tumour (ATRT)](https://onco.cc/cancers/atrt/), [Blastic plasmacytoid dendritic cell neoplasm (BPDCN)](https://onco.cc/cancers/bpdcn/), [Burkitt lymphoma](https://onco.cc/cancers/burkitt-lymphoma/), [Central nervous system germ cell tumours (germinoma and non-germinomatous)](https://onco.cc/cancers/cns-germ-cell-tumours/), [Diffuse large B-cell lymphoma](https://onco.cc/cancers/dlbcl/), [Enteropathy-associated T-cell lymphoma](https://onco.cc/cancers/enteropathy-associated-t-cell-lymphoma/), [Ewing sarcoma](https://onco.cc/cancers/ewing-sarcoma/), [Extragonadal germ cell tumour](https://onco.cc/cancers/extragonadal-germ-cell-tumour/), [Follicular lymphoma](https://onco.cc/cancers/follicular-lymphoma/), [Germ cell tumours of childhood and adolescence (extracranial and CNS)](https://onco.cc/cancers/paediatric-germ-cell-tumours/), [Gestational trophoblastic neoplasia](https://onco.cc/cancers/gestational-trophoblastic/), [Group 3 and group 4 medulloblastoma (non-WNT/non-SHH)](https://onco.cc/cancers/medulloblastoma-group-3-4/), [High-risk gestational trophoblastic neoplasia (FIGO score 7 or more, including ultra-high-risk)](https://onco.cc/cancers/high-risk-gtn/), [High-risk neuroblastoma](https://onco.cc/cancers/neuroblastoma-high-risk/), [HIV-associated (AIDS-related) lymphomas](https://onco.cc/cancers/hiv-associated-lymphoma/), [Hodgkin lymphoma](https://onco.cc/cancers/hodgkin-lymphoma/), [Mantle cell lymphoma](https://onco.cc/cancers/mantle-cell-lymphoma/), [Medulloblastoma](https://onco.cc/cancers/medulloblastoma/), [Multiple myeloma](https://onco.cc/cancers/multiple-myeloma/), [Neuroblastoma (paediatric)](https://onco.cc/cancers/neuroblastoma/), [Newly diagnosed multiple myeloma, transplant-eligible](https://onco.cc/cancers/myeloma-transplant-eligible/), [Nodal T-follicular helper cell lymphoma, angioimmunoblastic type (angioimmunoblastic T-cell lymphoma)](https://onco.cc/cancers/angioimmunoblastic-t-cell-lymphoma/), [Nodular lymphocyte-predominant Hodgkin lymphoma (nodular lymphocyte-predominant B-cell lymphoma)](https://onco.cc/cancers/nodular-lymphocyte-predominant-hodgkin-lymphoma/), [Non-Hodgkin lymphoma (all types)](https://onco.cc/cancers/non-hodgkin-lymphoma/), [Non-seminomatous germ cell tumour](https://onco.cc/cancers/non-seminoma/), [Peripheral T-cell lymphomas (including cutaneous T-cell lymphoma)](https://onco.cc/cancers/peripheral-t-cell-lymphoma/), [Placental-site trophoblastic tumour and epithelioid trophoblastic tumour](https://onco.cc/cancers/placental-site-trophoblastic-tumour/), [Plasma cell leukaemia](https://onco.cc/cancers/plasma-cell-leukaemia/), [Primary CNS lymphoma](https://onco.cc/cancers/primary-cns-lymphoma/), [Primary large B-cell lymphoma of the testis](https://onco.cc/cancers/primary-testicular-lymphoma/), [Primary mediastinal (thymic) large B-cell lymphoma](https://onco.cc/cancers/primary-mediastinal-b-cell-lymphoma/), [Relapsed and refractory classical Hodgkin lymphoma](https://onco.cc/cancers/relapsed-refractory-hodgkin-lymphoma/), [Retinoblastoma](https://onco.cc/cancers/retinoblastoma/), [Richter transformation of chronic lymphocytic leukaemia](https://onco.cc/cancers/richter-transformation-cll/), [SHH-activated medulloblastoma](https://onco.cc/cancers/medulloblastoma-shh/), [Testicular germ cell tumours](https://onco.cc/cancers/testicular/), [Waldenström macroglobulinaemia](https://onco.cc/cancers/waldenstrom/)
- fronts: [Cell Therapy](https://onco.cc/fronts/cell-therapy/), [Chemotherapy](https://onco.cc/fronts/chemotherapy/)
- technologies: [After a transplant or cell therapy: what to ask for](https://onco.cc/technologies/rejuv-tx-what-to-ask-for/), [Apheresis and starting-material collection](https://onco.cc/technologies/apheresis-starting-material/), [Blood counts that do not come back after CAR-T: ICAHT](https://onco.cc/technologies/rejuv-tx-prolonged-cytopenias/), [Cryopreservation and cell-therapy cold chain](https://onco.cc/technologies/cell-therapy-cold-chain/), [Cytotoxic chemotherapy](https://onco.cc/technologies/cytotoxic-chemotherapy/), [Growth factors: G-CSF and febrile neutropenia prevention](https://onco.cc/technologies/g-csf-growth-factors/), [Hormones, metabolism and the heart after transplant](https://onco.cc/technologies/rejuv-tx-endocrine-and-cardiometabolic/), [Infection risk after transplant and cell therapy, phase by phase, and the prophylaxis that follows it](https://onco.cc/technologies/rejuv-tx-infection-by-phase/), [Iron overload after transplant](https://onco.cc/technologies/rejuv-tx-iron-overload/), [Late effects after a stem cell transplant](https://onco.cc/technologies/rejuv-tx-late-effects-overview/), [Rebuilding an immune system: the timeline, lineage by lineage](https://onco.cc/technologies/rejuv-tx-immune-reconstitution-timeline/), [Rebuilding the immune system after treatment](https://onco.cc/technologies/rejuv-frontier-immune-reconstitution/), [Revaccination after transplant: the schedules, and where the UK and the US differ](https://onco.cc/technologies/rejuv-tx-revaccination/), [Stem cell clinics and stem cell tourism](https://onco.cc/technologies/rejuv-frontier-stem-cell-tourism/), [Tandem autologous transplant](https://onco.cc/technologies/tandem-transplant/), [Who is supposed to be watching: EBMT, CIBMTR, FACT-JACIE, and what a survivor is actually offered](https://onco.cc/technologies/rejuv-tx-long-term-follow-up-frameworks/)
- drugs: [Carmustine](https://onco.cc/drugs/carmustine/), [Defibrotide](https://onco.cc/drugs/defibrotide/), [Etoposide](https://onco.cc/drugs/etoposide/), [Melphalan (including hepatic delivery system)](https://onco.cc/drugs/melphalan/), [Palifermin](https://onco.cc/drugs/palifermin/), [Plerixafor](https://onco.cc/drugs/plerixafor/), [Thiotepa](https://onco.cc/drugs/thiotepa/)
- companies: [Angiocrine Bioscience](https://onco.cc/companies/angiocrine-bioscience/)
- terms: [Minimal / molecular residual disease (MRD)](https://onco.cc/terms/mrd/), [Stem cell transplant in lymphoma: what it is still for](https://onco.cc/terms/lymphoma-tx-transplant-role/), [Transplant or CAR-T at second line in diffuse large B-cell lymphoma](https://onco.cc/terms/lymphoma-decision-transplant-or-car-t/)
- trials: [ACNS0122](https://onco.cc/trials/acns0122/), [ACNS0333](https://onco.cc/trials/acns0333/), [AETHERA](https://onco.cc/trials/aethera/), [ANBL17P1](https://onco.cc/trials/anbl17p1/), [BMT CTN 0803](https://onco.cc/trials/bmt-ctn-0803/), [CARTITUDE-5](https://onco.cc/trials/cartitude-5/), [COG ANBL0532](https://onco.cc/trials/anbl0532/), [IELSG32](https://onco.cc/trials/ielsg32/), [MATRix/IELSG43](https://onco.cc/trials/ielsg43/), [PERSEUS](https://onco.cc/trials/perseus/), [SIOPEN HR-NBL1](https://onco.cc/trials/hr-nbl1/), [Study 2005-01](https://onco.cc/trials/study-2005-01/), [TIGER: standard-dose TIP versus high-dose TI-CE with stem cell transplant as first salvage for relapsed germ cell tumours](https://onco.cc/trials/tiger-trial/), [TRIANGLE](https://onco.cc/trials/triangle/), [ZUMA-7](https://onco.cc/trials/zuma-7/)
- pairings: [Early relapse: CAR-T before transplant](https://onco.cc/pairings/car-t-before-transplant-lbcl/)
- ideas: [One CAR-T infusion instead of autologous transplant](https://onco.cc/ideas/idea-car-t-replaces-transplant/)
- people: [John F. DiPersio](https://onco.cc/people/john-dipersio/), [Paul G. Richardson](https://onco.cc/people/paul-richardson/)
- targets: [CXCR4](https://onco.cc/targets/cxcr4/)
- key papers: [PERSEUS: daratumumab added to bortezomib-lenalidomide-dexamethasone around autologous transplant in newly diagnosed myeloma](https://onco.cc/key-papers/paper-perseus-dara-vrd-transplant-nejm-2024/), [TRANSFORM: liso-cel CAR-T versus salvage chemotherapy and transplant in early-relapsing large B-cell lymphoma](https://onco.cc/key-papers/paper-transform-liso-cel-lancet-2022/), [ZUMA-7: axi-cel CAR-T instead of salvage chemotherapy and transplant for large B-cell lymphoma that relapses early](https://onco.cc/key-papers/paper-zuma-7-axi-cel-second-line-nejm-2022/)

---
JSON: https://onco.cc/api/v1/entities/autologous-stem-cell-transplant.json