ASTCT Clinical Practice recommendations for transplant and cellular therapies in multiple myeloma
Binod Dhakal 1 , Nina Shah 2 , Ankit Kansagra 3 , Ambuj Kumar 4 , Sagar Lonial 5 , Alfred Garfall 6 , Andrew Cowan 7 , Bishesh Sharma Poudyal 8 , Caitlin Costello 9 , Francesca Gay 10 , Gordon Cook 11 , Hang Quach 12 , Herman Einsele 13 , Jeff Schriber 14 , Jian Hou 15 , Luciano Costa 16 , Mahmoud Aljurf 17 , Maria Chaudhry 18 , Meral Beksac 19 , Miles Prince 20 , Mohamad Mohty 21 , Murali Janakiram 22 , Natalie Callander 23 , Noa Biran 24 , Pankaj Malhotra 25 , Paula Rodriguez Otero 26 , Philippe Moreau 27 , Rafat Abonour 28 , Raheel Iftikhar 29 , Rebecca Silberman 30 , Sham Mailankody 31 , Tara Gregory 32 , Yi Lin 33 , Paul Carpenter 34 , Mehdi Hamadani 35 , Saad Usmani 31 , Shaji Kumar 33
Over the past decade, therapeutic options in multiple myeloma (MM) have changed dramatically. Given the unprecedented efficacy of novel agents, the role of hematopoietic cell transplantation (HCT) in MM remains under scrutiny.
Rapid advances in myeloma immunotherapy including the recent approval of chimeric antigen receptor (CAR) T-cell therapy will impact the MM therapeutic landscape. The American Society for Transplantation and Cellular Therapy (ASTCT) convened an expert panel to formulate clinical practice recommendations for role, timing, and sequencing of autologous (auto-HCT), allogeneic (allo-HCT) and CAR T-cell therapy for patients with newly diagnosed (NDMM) and relapsed/refractory MM (RRMM).
The RAND-modified Delphi method was used to generate consensus statements. Twenty consensus statements were generated. The panel endorsed continued use of auto-HCT consolidation for patients with NDMM as a standard-of-care option, whereas in the front line allo-HCT and CAR-T were not recommended outside the setting of clinical trial.
For patients not undergoing auto-HCT upfront, the panel recommended its use in first relapse. Lenalidomide as a single agent was recommended for maintenance especially for standard risk patients. In the RRMM setting, the panel recommended the use of CAR-T in patients with 4 or more prior lines of therapy.
The panel encouraged allo-HCT in RRMM setting only in the context of clinical trial. The panel found RAND-modified Delphi methodology effective in providing a formal framework for developing consensus recommendations for the timing and sequence of cellular therapies for MM.