This large single-center study looked at outcomes when people with relapsed multiple myeloma received a second autologous hematopoietic cell transplant (autoHCT) either later in their disease course ("delayed") or as a planned salvage treatment. The team reviewed 650 patients treated from 2006–2023 and reported real-world safety and survival data. Below we explain the main findings in plain language and highlight what they mean for stem cell preservation, aging, and future regenerative therapies.
The study reviewed 650 patients who received a delayed (n = 335) or salvage (n = 315) autologous hematopoietic cell transplant between 2006–2023.
Median age was 61.4 years; the population included 22% Black patients and 21% with high-risk cytogenetics (chromosome changes linked to worse outcomes).
Many had been heavily pre-treated: 49% had >3 prior therapy lines and 33% were lenalidomide-refractory (their cancer no longer responded to lenalidomide).
Short-term non-relapse mortality (death not due to myeloma) was low: 3% at day 100 and 4% at 1 year.
Overall median progression-free survival (mPFS) was 17.5 months and median overall survival (mOS) 47.3 months for the whole group.
There was no major difference in outcomes between delayed vs. salvage autoHCT overall (mPFS 16.3 vs 19.1 months; mOS 43.2 vs 50.8 months).
For patients having a salvage autoHCT after a prior autoHCT, timing mattered: receiving the second transplant ≥24 months after the first was linked to much better outcomes (mPFS 20.6 vs 8.4 months; mOS 54.6 vs 12.5 months; p < 0.001).
Factors associated with worse outcomes included: high-risk cytogenetics, higher disease stage (R-ISS II–III), disease refractory to lenalidomide or carfilzomib, no prior exposure to anti-CD38 antibodies, and having >3 prior therapy lines.
Achieving a complete response (CR) after transplant and receiving maintenance therapy afterward were linked to better outcomes.
If you or a loved one is facing relapsed multiple myeloma, this study shows that a second transplant using your own stem cells can still be feasible and effective for many patients. Key takeaways:
A second autologous transplant is generally safe with low early treatment-related death rates.
Timing matters: patients who had a longer first remission (at least 2 years) before relapse tended to do much better with a salvage transplant.
Getting to a deep response after transplant and then receiving maintenance therapy helps extend how long the benefit lasts.
For people who bank their own stem cells (autologous cell preservation), having a stored product or the ability to remobilize good-quality cells can provide the option of a later transplant if needed.
Autologous hematopoietic cell transplantation (autoHCT) uses a patient’s own blood-forming (hematopoietic) stem cells. Doctors collect these cells, give high-dose chemotherapy to remove cancer cells, then return the stored stem cells to the patient so the blood and immune system can recover.
Because the cells are the patient’s own, the risk of immune rejection is low. Success depends on collecting a sufficient number of healthy stem cells and the patient’s disease status at transplant.
Study type: Retrospective chart review at a single large center (2006–2023).
Patients: 650 total (335 delayed, 315 salvage).
Important numeric results:
Non-relapse mortality: 3% (day 100), 4% (1 year).
Whole-group mPFS: 17.5 months; mOS: 47.3 months.
Delayed vs salvage: similar overall outcomes (mPFS 16.3 vs 19.1 months; mOS 43.2 vs 50.8 months).
Salvage subgroup timing effect: second transplant ≥24 months after the first had mPFS 20.6 vs 8.4 months and mOS 54.6 vs 12.5 months (statistically significant, p < 0.001).
Predictors of outcome identified in multivariable analysis (factors linked to poorer PFS/OS):
High-risk cytogenetics
Higher R-ISS stage (II–III)
Disease refractory to lenalidomide or carfilzomib
No prior exposure to anti-CD38 antibodies
More than 3 prior therapy lines
Positive predictors: achieving complete response (CR) after transplant and receiving maintenance therapy.
This is a retrospective single-center study, which can reflect real-world practice but is not randomized.
Treatment options for relapsed myeloma have changed quickly (CAR-T cells, bispecific antibodies, newer targeted drugs). The data here provide a benchmark for standard transplant outcomes as those newer therapies are integrated.
Stem cell banking (preserving a patient’s own hematopoietic stem cells) gives an additional future treatment option: if the myeloma returns years later, a stored product can allow a salvage autologous transplant without needing to remobilize cells.
Quality and timing matter: older donors or heavily pre-treated patients may have lower-quality or harder-to-mobilize cells. Banking earlier—when cells are healthier—can improve the ability to use them later.
For longevity and regenerative medicine: the study highlights practical value in preserving healthy autologous cells. Autologous cells are less likely to be rejected and can be used not only for cancer rescue but may inform future regenerative protocols that reuse a person’s own cells for repair.
However, newer cellular therapies (CAR-T, bispecific antibodies) are changing treatment algorithms. Transplant remains an important, well-established tool, and banking strategies should consider the full landscape of current and emerging therapies.
If you are eligible and considering upfront stem cell collection for future use, discuss timing with your care team—earlier collection can preserve higher-quality cells.
Ask about storage duration, quality control (CD34+ cell counts), and plans for possible remobilization if needed later.
Understand that a second autologous transplant can be a safe option later, particularly if your first remission lasted at least 2 years.
Pasvolsky O, Marcoux C, Milton DR, et al. Results of delayed or salvage autologous hematopoietic stem cell transplantation for multiple myeloma. Bone Marrow Transplantation. 2025. DOI: 10.1038/s41409-025-02771-3.
Selected related studies cited in the article (landmark trials and reviews):
Richardson PG et al. Triplet Therapy, Transplantation, and Maintenance until Progression in Myeloma. N Engl J Med. 2022.
Perrot A et al. Early Versus Late Autologous Stem Cell Transplant in Newly Diagnosed Multiple Myeloma. Blood. 2020.
Sonneveld P et al. Daratumumab, Bortezomib, Lenalidomide, and Dexamethasone for Multiple Myeloma. N Engl J Med. 2024.
(If you want the full reference list or the supplementary data from the paper, ask and we can provide direct citations and a plain-language summary of the supplement.)
