Autologous Stem Cell Transplantation in Multiple Myeloma: Is It Still the Gold Standard?

Multiple myeloma, the second most common hematologic malignancy, accounts for approximately 10% of all blood cancers. Therapeutic advances have transformed multiple myeloma from a uniformly fatal disease into a chronic, manageable condition. Autologous stem cell transplantation (ASCT) remains a cornerstone of frontline treatment, demonstrating superiority in progression-free survival (PFS) and minimal residual disease (MRD) negativity compared with chemotherapy alone or modern induction regimens without transplant. International guidelines continue to recommend ASCT as the standard of care for eligible patients. Maintenance therapy post ASCT further improves PFS and overall survival, although it carries a modestly increased risk of secondary malignancies. Meanwhile, novel immunotherapies, including chimeric antigen receptor T cells and bispecific antibodies, are reshaping treatment strategies, showing strong efficacy in relapsed/refractory multiple myeloma. Ongoing trials are evaluating their role in frontline settings, with the potential to complement or replace ASCT. The future of multiple myeloma management hinges on precision medicine, using MRD assessment, genomic profiling, and patient-specific risk stratification to guide therapy. As these personalized approaches are integrated alongside established therapies, the goal of achieving long-term remission and potentially a cure becomes increasingly attainable.