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. 2025 Mar;60(3):335-345.
doi: 10.1038/s41409-024-02490-1. Epub 2024 Dec 5.

Single versus tandem autologous stem cell transplantation in newly diagnosed multiple myeloma

Nora Grieb  1   2 , Alexander Oeser  1 , Maximilian Ferle  1   2   3 , Franziska Hanke  4 , Sarah Flossdorf  4   5 , Sandra Sauer  6 , Hartmut Goldschmidt  6   7 , Carsten Müller-Tidow  6 , Hans-Jürgen Salwender  8 , Roland Fenk  9 , Monika Engelhardt  10 , Robert Zeiser  10 , Vladan Vucinic  2 , Georg-Nikolaus Franke  2 , Igor Wolfgang Blau  11 , Daniel Teschner  12 , Hermann Einsele  12 , Christoph Kimmich  13 , Miriam Kull  14 , Britta Besemer  15 , Nico Gagelmann  16 , Nicolaus Kröger  4   16 , Thomas Neumuth  1   3 , Uwe Platzbecker  2 , Maximilian Merz  17 ; German Registry for Hematopoietic Stem Cell Transplantation and Cell Therapy (DRST)
Affiliations

Single versus tandem autologous stem cell transplantation in newly diagnosed multiple myeloma

Nora Grieb et al. Bone Marrow Transplant. 2025 Mar.

Abstract

Identifying patients who may benefit from autologous stem cell transplantation (ASCT) in newly diagnosed multiple myeloma is crucial, especially in the era of effective induction and consolidation strategies. We analyzed data from 12763 patients enrolled in the German Registry for Hematopoietic Stem Cell Transplantation and Cell Therapy (DRST), distinguishing those who underwent single (n = 8736) or tandem ASCT (n = 4027) from 1998 to 2021. Our findings show that the median age at first ASCT increased over time, while the use of tandem ASCT declined. The shift in treatment practices coincided with higher rates of complete response (CR) post-induction therapy. Significantly improved overall survival and event-free survival over time were observed across all age groups, especially in older patients, but not in patients under 40. Tandem ASCT showed benefits for patients who did not achieve CR after initial ASCT. However, patients with ISS III and renal impairment had poorer outcomes with tandem ASCT. In conclusion, while ASCT remains an important anti-myeloma tool, careful patient selection for tandem ASCT is essential, particularly avoiding its use in patients with ISS III and renal impairment, older age, and those already achieving CR after initial ASCT.

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Conflict of interest statement

Competing interests: The authors declare no competing interests. Ethics approval: All methods used were performed in accordance with the relevant guidelines and regulations. Data collection and analysis was approved by ethics committees of participating DRST centers and the study was performed according to the declaration of Helsinki. Informed consent was obtained from all participants.

Figures

Fig. 1
Fig. 1
Selection process and classification of cases included in the study.
Fig. 2
Fig. 2
Overall survival from first ASCT by age group and time period.
Fig. 3
Fig. 3. Benefit of tandem transplantation for remission after ASCT based on a 6 month landmark analysis.
Comparisons are shown in OS (a), in EFS (b), and of remission rates pre- and post ASCT across different time periods (c).
Fig. 4
Fig. 4
Benefit in OS of tandem ASCT for ISS and renal impairment status based on a 6 month landmark analysis.
See this image and copyright information in PMC

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