High-dose therapy (HDT) followed by autologous stem cell transplantation (ASCT) remains
the standard of care for patients younger than 65 years of age with multiple myeloma (MM).
However, this therapeutic approach has undergone substantial advances in this last decade, mainly
due to the introduction of new drugs such as thalidomide, lenalidomide and bortezomib. These new
drugs, in different combinations, have shown to significantly increase response rates after induction
therapy and ASCT. Moreover, the positive results obtained with these agents in consolidation and
maintenance strategies after ASCT strongly support the concept of continuous therapy, whose ultimate
goal is the long-term control of the disease and the improvement of outcome. Preliminary data
from studies investigating next generation proteasome inhibitors, such as carfilzomib and ixazomib,
used upfront as well as at subsequent therapeutic lines, demonstrate the possibility of achieving molecular
remission in most of the patients. The deeper responses obtained with new drugcombinations
questioned the role of ASCT, and large, ongoing, phase 3 trials will shed light on the
role and the timing of ASCT.