Publicaciones científicas

ASTCT Clinical Practice recommendations for transplant and cellular therapies in multiple myeloma

01-jun-2022 | Revista: Transplantation and Cellular Therapy

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.

CITA DE ARTÍCULO  Transplant Cell Ther. 2022 Jun;28(6):284-293.
doi: 10.1016/j.jtct.2022.03.019. Epub 2022 Mar 17.