{"entity":{"id":"myeloma-transplant-eligible","kind":"cancer","name":"Newly diagnosed multiple myeloma, transplant-eligible","aka":["Transplant-eligible myeloma","TE NDMM","Newly diagnosed myeloma, fit for autologous transplant"],"tldr":"Fit patients with newly diagnosed myeloma receive four drugs at once, then their own stem cells are collected, they are given high-dose chemotherapy, the cells are returned and they continue on maintenance. Adding the CD38 antibody daratumumab to the three-drug backbone, tested in PERSEUS and CASSIOPEIA, means most patients now reach a state where no myeloma can be detected.","summary":"Eligibility for autologous transplant rests on age, organ function and frailty rather than a fixed cut-off; most centres transplant to around 70 to 75. The sequence is three to six cycles of induction, stem cell mobilisation and collection, high-dose melphalan with autologous stem cell rescue, consolidation and then lenalidomide maintenance until progression. Two randomised trials settled the place of the transplant in the era of modern induction: IFM 2009 and DETERMINATION both showed a longer remission with early transplant after bortezomib-lenalidomide-dexamethasone (median progression-free survival 67.5 versus 46.2 months in DETERMINATION) but no survival difference, so delayed transplant at first relapse is an accepted choice.\n\nInduction moved from triplets to quadruplets on the strength of CD38 antibodies. CASSIOPEIA (2019) added daratumumab to bortezomib-thalidomide-dexamethasone and raised stringent complete responses after consolidation from 20 to 29 percent while cutting progression or death by about half. PERSEUS (2024) added daratumumab to bortezomib-lenalidomide-dexamethasone around transplant with daratumumab-lenalidomide maintenance: progression-free survival at four years 84.3 percent versus 67.7 percent (hazard ratio 0.42), with three in four patients reaching MRD negativity at 10^-5, and daratumumab-VRd became the standard induction with regulatory approval in 2024. Isatuximab quadruplets (IsKia, GMMG-HD7) show the same pattern.\n\nMaintenance with lenalidomide until progression lengthens life (Myeloma XI, CALGB 100104); whether to add a CD38 antibody, and whether MRD-negative patients can stop, are the questions of the MIDAS, DRAMMATIC and other MRD-adapted trials. The larger question is whether the transplant itself is still needed when quadruplets produce such deep responses, and CARTITUDE-6 is testing cilta-cel CAR-T in its place. High-risk cytogenetics (del(17p), t(4;14), t(14;16), gain or amplification of 1q) still predict early relapse and are treated with the deepest available regimens, sometimes with tandem transplant.","asOf":"2026-09-17","wikipedia":"https://en.wikipedia.org/wiki/Multiple_myeloma","links":[{"label":"Wikipedia","url":"https://en.wikipedia.org/wiki/Multiple_myeloma"},{"label":"NCCN Guidelines: Multiple Myeloma","url":"https://www.nccn.org/guidelines/guidelines-detail?category=1&id=1445"}],"tags":["subtype-page"],"related":[],"cancers":[],"sections":[],"technologies":["autologous-stem-cell-transplant","ngs-mrd-clonoseq"],"targets":["cd38","proteasome","cereblon"],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":["vrd","autologous-transplant","mrd-negativity-myeloma","high-risk-myeloma","r-iss","maintenance-therapy","proteasome-inhibitor","imid"],"trials":[],"people":[],"bottlenecks":[],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"group":"haematologic","burden":"Roughly four in ten people with newly diagnosed myeloma are fit enough for high-dose melphalan with an autologous stem cell transplant, generally those under about 70 without major organ disease.","subtypes":["Standard-risk transplant-eligible myeloma (R-ISS I or II without high-risk cytogenetics)","High-risk transplant-eligible myeloma (del(17p), t(4;14), t(14;16), gain 1q or R2-ISS high)","Transplant-deferred myeloma (stem cells collected, transplant kept for first relapse)","Light chain myeloma and IgA myeloma in fit patients"],"biomarkers":["R-ISS and R2-ISS stage","FISH: del(17p), t(4;14), t(14;16), gain or amplification 1q","Lactate dehydrogenase","Serum free light chains and M-protein","MRD by next-generation sequencing or flow cytometry at 10^-5 and 10^-6","Frailty and organ function for transplant fitness"],"standardOfCare":[{"setting":"Induction","approach":"Daratumumab plus bortezomib, lenalidomide and dexamethasone (PERSEUS) for four to six cycles; isatuximab-VRd or daratumumab-VTd (CASSIOPEIA) are alternatives.","refs":["daratumumab","bortezomib","lenalidomide","dexamethasone","perseus","isatuximab","vrd","cd38-plus-triplet"],"guideline":{"version":"NCCN Guidelines: Multiple Myeloma","url":"https://www.nccn.org/guidelines/guidelines-detail?category=1&id=1445"}},{"setting":"Consolidation","approach":"High-dose melphalan with autologous stem cell transplant, early or deferred to first relapse after stem cell collection; tandem transplant considered in high-risk disease.","refs":["melphalan","autologous-stem-cell-transplant","autologous-transplant"],"guideline":{"version":"NCCN Guidelines: Multiple Myeloma","url":"https://www.nccn.org/guidelines/guidelines-detail?category=1&id=1445"}},{"setting":"Maintenance","approach":"Lenalidomide until progression; daratumumab added after daratumumab-based induction (PERSEUS); bortezomib-containing maintenance in high-risk disease; MRD-guided stopping in trials.","refs":["lenalidomide","daratumumab","bortezomib","perseus","maintenance-therapy","idea-mrd-guided-stop-myeloma"],"guideline":{"version":"NCCN Guidelines: Multiple Myeloma","url":"https://www.nccn.org/guidelines/guidelines-detail?category=1&id=1445"}},{"setting":"Response assessment","approach":"M-protein and free light chains every cycle, MRD by sequencing or flow cytometry after transplant and during maintenance, imaging for residual focal lesions.","refs":["ngs-mrd-clonoseq","flow-cytometry-mrd","mrd-negativity-myeloma","whole-body-mri","pet-ct"]}],"stateOfArt":["A daratumumab quadruplet around autologous transplant is standard after PERSEUS; most patients reach MRD negativity and more than eight in ten are progression-free at four years.","Early transplant lengthens remission but not life compared with a deferred transplant, so both are offered.","CAR-T in place of transplant and MRD-guided stopping of maintenance are under randomised test."],"history":[{"year":1983,"title":"McElwain: high-dose melphalan produces remissions in myeloma","refs":["melphalan"]},{"year":1996,"title":"IFM 90: autologous transplant beats conventional chemotherapy","refs":["autologous-stem-cell-transplant"]},{"year":2003,"title":"Bortezomib approved; proteasome inhibition enters induction","refs":["bortezomib"]},{"year":2012,"title":"Lenalidomide maintenance after transplant lengthens remission (IFM 2005-02, CALGB 100104)","refs":["lenalidomide"]},{"year":2017,"title":"IFM 2009: early transplant lengthens remission but not life after VRd","refs":["vrd"]},{"year":2019,"title":"CASSIOPEIA: daratumumab quadruplet raises deep responses","refs":["daratumumab"]},{"year":2024,"title":"PERSEUS: daratumumab-VRd around transplant approved as standard induction","refs":["perseus","daratumumab"]}],"pipeline":["daratumumab","isatuximab","ciltacabtagene-autoleucel","cartitude-5","idea-car-t-replaces-transplant","idea-mrd-guided-stop-myeloma"],"openProblems":["Whether high-dose melphalan is still necessary after a quadruplet that produces MRD negativity.","Whether MRD-negative patients can stop maintenance safely.","High-risk cytogenetic disease still relapses early despite quadruplets."],"parent":"multiple-myeloma"},"route":"/cancers/myeloma-transplant-eligible/","neighbours":{"technology":[{"id":"autologous-stem-cell-transplant","kind":"technology","name":"Autologous stem cell transplant (high-dose therapy)","route":"/technologies/autologous-stem-cell-transplant/"},{"id":"flow-cytometry-mrd","kind":"technology","name":"Multiparameter flow cytometry MRD","route":"/technologies/flow-cytometry-mrd/"},{"id":"ngs-mrd-clonoseq","kind":"technology","name":"NGS-based MRD (clonoSEQ and molecular MRD)","route":"/technologies/ngs-mrd-clonoseq/"},{"id":"pet-ct","kind":"technology","name":"PET/CT","route":"/technologies/pet-ct/"},{"id":"whole-body-mri","kind":"technology","name":"Whole-body MRI","route":"/technologies/whole-body-mri/"}],"target":[{"id":"cd38","kind":"target","name":"CD38","route":"/targets/cd38/"},{"id":"cereblon","kind":"target","name":"Cereblon (CRBN)","route":"/targets/cereblon/"},{"id":"proteasome","kind":"target","name":"Proteasome (PSMB5)","route":"/targets/proteasome/"}],"term":[{"id":"autologous-transplant","kind":"term","name":"Autologous stem cell transplant (ASCT)","route":"/terms/autologous-transplant/"},{"id":"high-risk-myeloma","kind":"term","name":"High-risk cytogenetics (myeloma)","route":"/terms/high-risk-myeloma/"},{"id":"imid","kind":"term","name":"Immunomodulatory drugs (IMiDs) and CELMoDs","route":"/terms/imid/"},{"id":"maintenance-therapy","kind":"term","name":"Maintenance therapy","route":"/terms/maintenance-therapy/"},{"id":"mrd-negativity-myeloma","kind":"term","name":"MRD negativity (myeloma, 10⁻⁵ / 10⁻⁶)","route":"/terms/mrd-negativity-myeloma/"},{"id":"proteasome-inhibitor","kind":"term","name":"Proteasome inhibitor (bortezomib, carfilzomib, ixazomib)","route":"/terms/proteasome-inhibitor/"},{"id":"r-iss","kind":"term","name":"R-ISS / R2-ISS staging","route":"/terms/r-iss/"},{"id":"vrd","kind":"term","name":"VRd and Dara-VRd (myeloma induction regimens)","route":"/terms/vrd/"}],"drug":[{"id":"bortezomib","kind":"drug","name":"Bortezomib","route":"/drugs/bortezomib/"},{"id":"ciltacabtagene-autoleucel","kind":"drug","name":"Ciltacabtagene autoleucel","route":"/drugs/ciltacabtagene-autoleucel/"},{"id":"daratumumab","kind":"drug","name":"Daratumumab","route":"/drugs/daratumumab/"},{"id":"dexamethasone","kind":"drug","name":"Dexamethasone","route":"/drugs/dexamethasone/"},{"id":"isatuximab","kind":"drug","name":"Isatuximab","route":"/drugs/isatuximab/"},{"id":"lenalidomide","kind":"drug","name":"Lenalidomide","route":"/drugs/lenalidomide/"},{"id":"melphalan","kind":"drug","name":"Melphalan (including hepatic delivery system)","route":"/drugs/melphalan/"}],"trial":[{"id":"cartitude-5","kind":"trial","name":"CARTITUDE-5","route":"/trials/cartitude-5/"},{"id":"perseus","kind":"trial","name":"PERSEUS","route":"/trials/perseus/"}],"idea":[{"id":"idea-mrd-guided-stop-myeloma","kind":"idea","name":"MRD-guided treatment-free intervals in myeloma","route":"/ideas/idea-mrd-guided-stop-myeloma/"},{"id":"idea-car-t-replaces-transplant","kind":"idea","name":"One CAR-T infusion instead of autologous transplant","route":"/ideas/idea-car-t-replaces-transplant/"}],"pairing":[{"id":"cd38-plus-triplet","kind":"pairing","name":"CD38 antibody added to PI-IMiD-dex (quadruplet induction)","route":"/pairings/cd38-plus-triplet/"}],"cancer":[{"id":"multiple-myeloma","kind":"cancer","name":"Multiple myeloma","route":"/cancers/multiple-myeloma/"}]}}