Transplant in mye loma: who, when, and why?

High-dose mel pha lan supported by autol o gous trans plan ta tion has been the stan dard of care for eli gi ble patients with newly diag nosed mul ti ple mye loma for nearly 30 years. Several ran dom ized clin i cal tri als have reaffirmed the strong position of transplant in the era of triplets combining proteasome inhibitors, immunomodulatory drugs, and dexamethasone. Although qua dru plets are becom ing the stan dard in trans plan ta tion pro grams, no data are cur rently avail able on the need for a trans plant with new reg i mens incor po rat ing anti-CD38 mono clo nal antibodies. Outcomes remain het ero geneous, with dif fer ent response depths and dura tions depending on the cyto ge net ics at diag no sis. The improve ment of dis ease prog nos ti ca tion using sen si tive and spe cific tools allows for adapting the strat egy to ini tial and dynamic risks. This review exam ines which patients need a trans plant, when trans plan ta tion is pref er a ble, and why.