Professional Statements and Societal Positions Guidelines
National Comprehensive Cancer Network - 2021
The NCCN guidelines (v.7.2021) state that autologous HCT is the preferred option after induction therapy in transplant-eligible [individuals], but a delayed HCT after early stem cell collection and storage is appropriate as well (category 1 recommendation). A repeat HCT can be considered for refractory/progressive disease after primary treatment in [individuals] with prolonged response to initial HCT.
The NCCN recommends collecting enough stem cells for two (2) transplants in younger [individuals] if tandem transplant or salvage transplant would be considered. A tandem transplant with or without maintenance therapy can be considered for all [individuals] who are candidates for HCT and is an option for [individuals] who do not achieve at least a very good partial response after the first autologous HCT and those with high-risk features.
The NCCN states the following for allo-HCT: "Allogeneic HCT includes either myeloablative or nonmyeloablative (i.e.,"mini" transplant) transplants. Allogeneic HCT has been investigated as an alternative to autologous HCT to avoid the contamination of reinfused autologous tumor cells, but also to take advantage of the beneficial graft-versus-tumor effect associated with allogeneic transplants. However, lack of a suitable donor and increased morbidity has limited this approach, particularly for the typical older MM population". The guidelines also note that allogeneic HCT should be done in the context of a clinical trial when possible.
The NCCN guidelines recommend autologous HCT in [individuals] with POEMS syndrome who are eligible as sole therapy or as consolidation therapy after induction therapy.