New Evidence Supports Second Autologous Transplant Over Allogeneic Transplant for Relapsed Multiple Myeloma

Autologous stem cell transplantation (auto-SCT) remains the gold standard first-line therapy for patients with Multiple Myeloma. However, relapse after initial transplant is common, raising important questions about the best approach to salvage treatment. Should these patients undergo a second auto-SCT or consider allogeneic transplantation (allo-SCT), which carries the potential for cure—but also higher risks?

To answer this question, a recent systematic review by U.S. researchers, published in Cancer (2025), analyzed 815 patients using data from major registries including the CIBMTR and Japanese Society for Transplantation. Five studies directly comparing second auto-SCT and allo-SCT, as well as two studies evaluating outcomes in patients with or without a matched donor, were reviewed.

The findings strongly suggest that second auto-SCT is a more favorable choice for patients relapsing after initial transplant. While allo-SCT may offer theoretical curative potential, it comes with higher risks of treatment-related mortality and complications like GVHD (graft-versus-host disease). With the advancement of novel therapies, the role of allo-SCT is expected to decline further.

Implications for Clinical Decision-Making:
At BIOOCUS, we stay aligned with the latest international research to guide treatment strategies. For patients who relapse after a first auto-SCT, we now have stronger evidence supporting the use of a second auto-SCT rather than high-risk allo-SCT, especially in regions where access to cutting-edge therapies may be limited.