Hematopoietic stem cell transplantation (SCT) was introduced in the treatment of multiple
myeloma in the 1980s. In the autologous setting, the use of peripheral blood stem
cells instead of bone marrow has markedly improved feasibility. In fit patients who
have normal renal function and are younger than 65 years of age, randomized studies
have shown the superiority of autologous stem cell transplantation (ASCT) compared
with conventional chemotherapy. ASCT is now considered the standard of care in this
population of patients. It is currently challenged, however, by the introduction of
novel agents, such as thalidomide, bortezomib, and lenalidomide. The role of allogenic
SCT remains controversial, even with reduced intensity conditionings. Prospective
studies still are needed to evaluate the impact of both autologous and allogeneic
SCT in this new era.
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