Standard therapy versus autologous transplantation in multiple myeloma.

The IFM 90 trial was designed to compare conventional chemotherapy (CC) and high-dose therapy (HDT). This trial demonstrated a significant superiority of HDT over CC regarding response rate, event-free-survival, and overall survival. Further improvements of HDT can be expected both in terms of feasibility (with the combined use of hematopoietic growth factors and peripheral blood stem cells) and in terms of response rate (using tandem transplants). A substantial improvement in long-term survival, however, will require the development of effective maintenance therapy to control the minimal residual disease present after transplant.