{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,2]],"date-time":"2026-03-02T21:08:51Z","timestamp":1772485731995,"version":"3.50.1"},"reference-count":27,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2025,5,7]],"date-time":"2025-05-07T00:00:00Z","timestamp":1746576000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: The role of salvage autologous stem cell transplantation (SAT) in relapsed multiple myeloma (MM) has been increasingly questioned, particularly with the emergence of novel immunotherapies and cellular therapies. This study aimed to evaluate the efficacy of SAT in a cohort of patients with relapsed MM following their first autologous stem cell transplantation (ASCT). Materials and Methods: A retrospective analysis was conducted on 78 patients from our institutional registry who underwent SAT for relapsed MM between April 2008 and October 2023. The primary endpoint was the progression-free survival (PFS), with secondary endpoints including the overall survival (OS) and overall response rates (ORRs) on day +100 after SAT. Results: The median age of the patients was 62 years (range: 48\u201378), and 32% were female. Most patients (81%) received reinduction therapy before SAT. The median PFS and OS from SAT were 24 months (95% CI: 20\u201336) and 76 months (95% CI: 48-NR), respectively. The ORR was 85%, and 65% achieved at least a very good partial response (VGPR). No significant differences in the PFS were found between subgroups based on the maintenance following SAT (hazard ratio (HR) = 0.93, 95% CI: 0.48\u20131.8, p = 0.831), cytogenetic risk (standard vs. high-risk) (HR = 0.98, 95% CI: 0.49\u20131.99, p = 0.969), age (&lt;60 years vs. \u226560 years) (HR = 0.96, 95% CI: 0.5\u20131.85, p = 0.912) or number of prior treatment lines (&lt;3 vs. \u22653) (HR = 0.186, 95% CI: 0.95\u20133.61, p = 0.069). The duration of remission after the first ASCT did not influence the PFS or OS following SAT (HR = 1.63, 95% CI: 0.78\u20133.39, p = 0.193 and HR = 1.2, 95% CI: 0.46\u20133.09, p = 0.7130). Conclusions: Salvage autologous stem cell transplantation remains a viable treatment option for patients with relapsed MM, particularly in resource-limited countries or for patients who prefer short, fixed-duration therapy. However, as is known from previous studies, maintenance therapy is crucial for achieving longer PFS. In this study, no statistically significant factors were identified to predict the benefit, underscoring the need for further research to optimize patient selection.<\/jats:p>","DOI":"10.3390\/medicina61050859","type":"journal-article","created":{"date-parts":[[2025,5,7]],"date-time":"2025-05-07T05:18:20Z","timestamp":1746595100000},"page":"859","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Is Salvage Autologous Stem Cell Transplantation Still a Viable Treatment Option in Relapsed Myeloma Patients?"],"prefix":"10.3390","volume":"61","author":[{"given":"Luka","family":"\u010cema\u017ear","sequence":"first","affiliation":[{"name":"Department of Hematology, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6283-9720","authenticated-orcid":false,"given":"Matev\u017e","family":"\u0160kerget","sequence":"additional","affiliation":[{"name":"Department of Hematology, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia"},{"name":"Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Barbara","family":"Skopec","sequence":"additional","affiliation":[{"name":"Department of Hematology, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia"},{"name":"Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,5,7]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"543","DOI":"10.1038\/s41375-024-02482-6","article-title":"International Myeloma Working Group Immunotherapy Committee Recommendation on Sequencing Immunotherapy for Treatment of Multiple Myeloma","volume":"39","author":"Costa","year":"2025","journal-title":"Leukemia"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"495","DOI":"10.1056\/NEJMoa2203478","article-title":"Teclistamab in Relapsed or Refractory Multiple Myeloma","volume":"387","author":"Moreau","year":"2022","journal-title":"N. Engl. J. Med."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"2259","DOI":"10.1038\/s41591-023-02528-9","article-title":"Elranatamab in Relapsed or Refractory Multiple Myeloma: Phase 2 MagnetisMM-3 Trial Results","volume":"29","author":"Lesokhin","year":"2023","journal-title":"Nat. Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"e136","DOI":"10.1002\/hem3.136","article-title":"Long-Term Survival and Safety of Elranatamab in Patients with Relapsed or Refractory Multiple Myeloma: Update from the MagnetisMM-3 Study","volume":"8","author":"Tomasson","year":"2024","journal-title":"HemaSphere"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"314","DOI":"10.1016\/S0140-6736(21)00933-8","article-title":"Ciltacabtagene Autoleucel, a B-Cell Maturation Antigen-Directed Chimeric Antigen Receptor T-Cell Therapy in Patients with Relapsed or Refractory Multiple Myeloma (CARTITUDE-1): A Phase 1b\/2 Open-Label Study","volume":"398","author":"Berdeja","year":"2021","journal-title":"Lancet Lond. Engl."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"335","DOI":"10.1056\/NEJMoa2303379","article-title":"Cilta-Cel or Standard Care in Lenalidomide-Refractory Multiple Myeloma","volume":"389","author":"Dhakal","year":"2023","journal-title":"N. Engl. J. Med."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Sureda, A., Corbacioglu, S., Greco, R., Kr\u00f6ger, N., and Carreras, E. (2024). Multiple Myeloma. The EBMT Handbook: Hematopoietic Cell Transplantation and Cellular Therapies, Springer.","DOI":"10.1007\/978-3-031-44080-9"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"5699","DOI":"10.1182\/blood-2019-130558","article-title":"Outcomes of Salvage Autologous Stem Cell Transplantation in Relapsed Multiple Myeloma: A Meta-Analysis","volume":"134","author":"Dadi","year":"2019","journal-title":"Blood"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"e95","DOI":"10.1002\/acg2.95","article-title":"Approaching the First Relapse after Autologous Transplant in Multiple Myeloma","volume":"4","author":"Atrash","year":"2021","journal-title":"Adv. Cell Gene Ther."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"e105","DOI":"10.1016\/S1470-2045(20)30756-7","article-title":"Treatment of Relapsed and Refractory Multiple Myeloma: Recommendations from the International Myeloma Working Group","volume":"22","author":"Moreau","year":"2021","journal-title":"Lancet Oncol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"156","DOI":"10.1111\/j.1445-5994.2012.02867.x","article-title":"Relapsed Multiple Myeloma: Who Benefits from Salvage Autografts?","volume":"43","author":"Chow","year":"2013","journal-title":"Intern. Med. J."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1780","DOI":"10.1182\/blood.2024027342","article-title":"Salvage Autologous Transplant in Relapsed Multiple Myeloma: Long-Term Follow-Up of the Phase III GMMG ReLApsE Trial","volume":"145","author":"Baertsch","year":"2025","journal-title":"Blood"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"e340","DOI":"10.1016\/S2352-3026(16)30049-7","article-title":"The Effect of Salvage Autologous Stem-Cell Transplantation on Overall Survival in Patients with Relapsed Multiple Myeloma (Final Results from BSBMT\/UKMF Myeloma X Relapse [Intensive]): A Randomised, Open-Label, Phase 3 Trial","volume":"3","author":"Cook","year":"2016","journal-title":"Lancet Haematol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1134","DOI":"10.1038\/s41375-020-0948-0","article-title":"Salvage Autologous Transplant and Lenalidomide Maintenance vs. Lenalidomide\/Dexamethasone for Relapsed Multiple Myeloma: The Randomized GMMG Phase III Trial ReLApsE","volume":"35","author":"Goldschmidt","year":"2021","journal-title":"Leukemia"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"2438","DOI":"10.1002\/cncr.28104","article-title":"Autologous Retransplantation for Patients with Recurrent Multiple Myeloma: A Single-Center Experience with 200 Patients","volume":"119","author":"Sellner","year":"2013","journal-title":"Cancer"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1086","DOI":"10.1002\/ajh.26590","article-title":"Multiple Myeloma: 2022 Update on Diagnosis, Risk-Stratification and Management","volume":"97","author":"Rajkumar","year":"2022","journal-title":"Am. J. Hematol."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Yarlagadda, L., Gundarlapalli, S., Parikh, R., Landes, R.D., Kottarathara, M., Ogunsesan, Y., Hoque, S., Mitma, A.A., Bailey, C., and Hill, K.M. (2021). Salvage Autologous Stem Cell Transplantation in Daratumumab-Refractory Multiple Myeloma. Cancers, 13.","DOI":"10.3390\/cancers13164019"},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Boussi, L.S., Avigan, Z.M., and Rosenblatt, J. (2022). Immunotherapy for the Treatment of Multiple Myeloma. Front. Immunol., 13.","DOI":"10.3389\/fimmu.2022.1027385"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1611851","DOI":"10.3389\/pore.2024.1611851","article-title":"The Efficacy and Safety of Second Salvage Autologous Transplantation in Myeloma Patients","volume":"30","author":"Bicsko","year":"2024","journal-title":"Pathol. Oncol. Res."},{"key":"ref_20","unstructured":"Mateos, M.V., San-Miguel, J., Dhakal, B., Lendvai, N., Vogel, M., Li, K., Chen, D., Patel, N., Einsele, H., and Martinez-Lopez, J. (April, January 30). Overall survival with ciltacabtagene autoleucel versus standard of care in lenalidomide-refractory multiple myeloma: Phase 3 CARTITUDE-4 study update. Presented at the 51st Annual EBMT Meeting, Florence, Italy. Abstract OS14-02."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"880","DOI":"10.1038\/s41409-024-02208-3","article-title":"Treatment Pattern and Outcomes of Re-Induction Therapy Prior to Stem Cell Transplantation in Patients with Relapsed\/Refractory Multiple Myeloma in Germany","volume":"59","author":"Sauer","year":"2024","journal-title":"Bone Marrow Transplant."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"2226","DOI":"10.1182\/blood-2023-181233","article-title":"Salvage Autologous Stem Cell Transplant for the Treatment of First Relapse Multiple Myeloma: Evidence of Its Clinical Role from a Multicenter Italian Study","volume":"142","author":"Mangiacavalli","year":"2023","journal-title":"Blood"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"3279","DOI":"10.1200\/JCO.2017.72.6679","article-title":"Lenalidomide Maintenance After Autologous Stem-Cell Transplantation in Newly Diagnosed Multiple Myeloma: A Meta-Analysis","volume":"35","author":"McCarthy","year":"2017","journal-title":"J. Clin. Oncol. Off. J. Am. Soc. Clin. Oncol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1038\/s41409-021-01455-y","article-title":"Maintenance Therapy after Second Autologous Hematopoietic Cell Transplantation for Multiple Myeloma. A CIBMTR Analysis","volume":"57","author":"Pasvolsky","year":"2022","journal-title":"Bone Marrow Transplant."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Baertsch, M.-A., Fougereau, M., Hielscher, T., Sauer, S., Breitkreutz, I., Jordan, K., M\u00fcller-Tidow, C., Goldschmidt, H., Raab, M.-S., and Hillengass, J. (2021). Carfilzomib, Lenalidomide, and Dexamethasone Followed by Salvage Autologous Stem Cell Transplant with or without Maintenance for Relapsed or Refractory Multiple Myeloma. Cancers, 13.","DOI":"10.3390\/cancers13184706"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"3592","DOI":"10.1182\/blood-2023-184945","article-title":"Salvage Transplant Versus CAR-T Cell Therapy for Relapsed Multiple Myeloma","volume":"142","author":"Gagelmann","year":"2023","journal-title":"Blood"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"6920","DOI":"10.1182\/blood-2024-202585","article-title":"The Role of Salvage Autologous Stem Cell Transplantation in Relapsed Multiple Myeloma\u2014A Single Center Experience at Umc Ljubljana","volume":"144","author":"Skopec","year":"2024","journal-title":"Blood"}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/61\/5\/859\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T17:28:32Z","timestamp":1760030912000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/61\/5\/859"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,5,7]]},"references-count":27,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2025,5]]}},"alternative-id":["medicina61050859"],"URL":"https:\/\/doi.org\/10.3390\/medicina61050859","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,5,7]]}}}