Kaur Discusses the Declining Role of Autologous Transplant in Myeloma

Gurbakhash Kaur, MD, an assistant professor of internal medicine at Mount Sinai Health System, discusses the shifting role of autologous stem cell transplant (ASCT) in an era increasingly defined by quadruplet regimens, CAR T-cell therapy, and bispecific antibodies.

Speaking with Targeted Oncology at the 23rd International Myeloma Society (IMS) Annual Meeting, held September 23-26, 2026, in Glasgow, Scotland, Kaur noted that quadruplet therapy has already become standard practice at academic centers and is poised for broader uptake in the community setting.

"The role of transplant is going to continue to diminish in countries where there's accessibility to CAR T-cell therapy and novel immunotherapies in the frontline space," Kaur says.

She emphasized that melphalan-based ASCT remains highly effective, but its short-term toxicity and the associated hit to quality of life make it a less attractive choice when bispecific antibodies and CAR T-cell therapy are available and capable of producing deep, durable remissions. In countries where those options remain inaccessible, Kaur said transplant will likely stay central to the newly diagnosed treatment paradigm for the foreseeable future.

As frontline ASCT use declines in markets with broader access, Kaur said the field should expect a corresponding uptick in immunotherapy-based approaches moving into the first- and second-line settings—a shift she framed as a redistribution of treatment intensity rather than a simple retirement of transplant.