{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T20:34:27Z","timestamp":1789590867114,"version":"build-2803163510"},"reference-count":30,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2026,2,28]],"date-time":"2026-02-28T00:00:00Z","timestamp":1772236800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Current Oncology"],"abstract":"<jats:p>Background: The role of second or salvage autologous stem cell transplantation (ASCT2) in relapsed multiple myeloma (MM) has evolved substantially over the past decade with the introduction of novel agents, maintenance strategies, and cellular immunotherapies. The clinical value of ASCT2 in the contemporary era requires reappraisal based on modern real-world and prospective data. Methods: We conducted a targeted literature review of PubMed-indexed studies published between January 2016 and January 2026 evaluating second or salvage autologous transplantation in adult patients with relapsed or refractory multiple myeloma. Retrospective registry analyses, real-world cohorts, and prospective randomized trials were included, focusing on feasibility, toxicity, progression-free survival (PFS), overall survival (OS), and prognostic determinants. Fourteen key studies formed the core evidence base, supplemented by guideline statements and comparative immunotherapy data. Results: Across large registry and institutional series, ASCT2 was consistently feasible with low non-relapse mortality (\u22645% at day 100\u20131 year). The median PFS ranged from 9.8 to 30.2 months and the median OS from approximately 30 to &gt;80 months, with outcomes strongly influenced by duration of remission after first ASCT. Patients relapsing \u226524 months after ASCT1 derived the greatest benefit, achieving a median PFS of 17\u201345 months and OS exceeding 60 months in favorable-risk subgroups. Post-ASCT2 maintenance, particularly with lenalidomide or carfilzomib-based regimens, significantly prolonged disease control in randomized and real-world studies. Conversely, the phase III GMMG ReLApsE trial did not demonstrate a survival advantage for routine salvage ASCT over continuous lenalidomide-based therapy, highlighting the importance of patient selection. In heavily refractory or cytopenic populations, ASCT2 provided modest disease control but enabled hematopoietic recovery and access to subsequent therapies. Conclusions: In the modern treatment landscape, second or salvage autologous transplantation remains a valid, safe, and effective strategy for carefully selected patients with relapsed multiple myeloma, particularly those with chemosensitive disease and prolonged initial remissions. ASCT2 should be integrated in a risk-adapted manner alongside maintenance therapy and emerging immunotherapies, serving as a durable consolidation or bridging approach rather than routine therapy for all relapsed patients.<\/jats:p>","DOI":"10.3390\/curroncol33030140","type":"journal-article","created":{"date-parts":[[2026,3,2]],"date-time":"2026-03-02T08:51:57Z","timestamp":1772441517000},"page":"140","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Salvage or Second Autologous SCT in Relapsed Multiple Myeloma (2016\u20132026): A Decade in Review"],"prefix":"10.3390","volume":"33","author":[{"given":"Marwa","family":"Nassar","sequence":"first","affiliation":[{"name":"Adult Hematology, Transplantation and Cellular Therapy Department, Oncology Center, King Faisal Specialist Hospital and Research Center, Riyadh 12713, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nourah","family":"Alzaidy","sequence":"additional","affiliation":[{"name":"Adult Hematology, Transplantation and Cellular Therapy Department, Oncology Center, King Faisal Specialist Hospital and Research Center, Riyadh 12713, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9401-810X","authenticated-orcid":false,"given":"Abdulrahman","family":"Nasiri","sequence":"additional","affiliation":[{"name":"College of Medicine, Imam Mohammad Ibn Saud Islamic University (IMSIU), Riyadh 11432, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2105-1048","authenticated-orcid":false,"given":"Amr","family":"Hanbali","sequence":"additional","affiliation":[{"name":"Adult Hematology, Transplantation and Cellular Therapy Department, Oncology Center, King Faisal Specialist Hospital and Research Center, Riyadh 12713, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mahmoud A.","family":"Aljurf","sequence":"additional","affiliation":[{"name":"Adult Hematology, Transplantation and Cellular Therapy Department, Oncology Center, King Faisal Specialist Hospital and Research Center, Riyadh 12713, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8123-8405","authenticated-orcid":false,"given":"Mostafa F.","family":"Mohammed Saleh","sequence":"additional","affiliation":[{"name":"Adult Hematology, Transplantation and Cellular Therapy Department, Oncology Center, King Faisal Specialist Hospital and Research Center, Riyadh 12713, Saudi Arabia"},{"name":"Clinical Hematology Unit, Department of Internal Medicine, Faculty of Medicine, Assiut University, Assiut 71515, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,2,28]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2075","DOI":"10.1016\/S0140-6736(10)61424-9","article-title":"Bortezomib with thalidomide plus dexamethasone compared with thalidomide plus dexamethasone as induction therapy before, and consolidation therapy after, double autologous stem-cell transplantation in newly diagnosed multiple myeloma: A randomised phase 3 study","volume":"376","author":"Cavo","year":"2010","journal-title":"Lancet"},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"\u010cema\u017ear, L., \u0160kerget, M., and Skopec, B. 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