Autologous Stem Cell Transplant (ASCT)
High-dose chemotherapy followed by stem cell rescue — eradicates plasma cell clone
- Response rate
- 5-year PFS 75%; neurologic improvement near-universal
- Onset
- Months (hematologic), 6-12 months (neurologic)
- Route
- IV (conditioning + stem cell infusion)
- Line
- 1st
- IgM effect
- N/A
Evidence summary
For transplant-eligible patients with disseminated disease, ASCT achieves excellent outcomes. The Mayo Clinic series (59 patients) showed 98% PFS at 1 year, 75% at 5 years. VEGF response pre-ASCT predicts better outcomes (5-year clinical PFS 90.9% vs 47.4%). In the comparative study (Zhao et al. 2019), ASCT had the highest hematologic CR rate (49.7%) among first-line options. Pulmonary morbidity improves post-ASCT.