The Fellow on Call: The Heme/Onc Podcast Episode 148: Myeloma Series, Pt. 8- Transplant in Multiple Myeloma (2026)
Mar 12, 2026
Dr. Amar Kelkar, Dana-Farber transplant physician focused on allogeneic transplant and ethics, and Dr. Shonali Midha, Dana-Farber myeloma specialist and autologous transplant expert, discuss transplant candidacy and pre-transplant testing. They walk through stem cell collection and mobilization, melphalan dosing, MRD-adapted strategies, second transplants, allogeneic roles, and financial/cost-effectiveness considerations.
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Assess Transplant Eligibility Individually
- Do individualize transplant eligibility by assessing age, performance status, frailty, cytogenetic risk, organ function and patient preferences.
- Shonali Midha emphasizes discussing quality-of-life, caregiver availability and a realistic ~90-day recovery expectation before transplant.
Practical Stem Cell Collection Steps
- Do plan stem cell collection after 4–6 cycles and hold therapy 3–4 weeks before apheresis while repeating pre-transplant testing and marrow assessment.
- Shonali Midha describes mobilization with G-CSF ± plerixafor, day-before CD34 check, tunneled line placement and 1–3 days of outpatient apheresis aiming for 4×10^6 CD34/kg.
How Plerixafor Mobilizes Stem Cells
- Insight: Plerixafor and cyclophosphamide both mobilize by disrupting CXCR4-mediated retention but via different mechanisms.
- Shonali Midha explains cyclophosphamide induces proteases to cleave adhesion molecules while plerixafor selectively inhibits CXCR4 to release stem cells.