One of the very interesting things that happens at this meeting that doesn’t really happen at most big meetings like ASH or ASCO is that there’s a format here where people argue their opinions on how to approach things. One of the subjects that has been controversial in myeloma for the last twenty years is what is the role of autologous stem cell transplant.
People started doing autologous stem cell transplants for multiple myeloma in the 1980s and every year since then people say stem cell transplant is going away because we’ve developed new drugs, we’ve developed new combinations. The consensus at the end of this fun and fairly vigorous argument between the people who are on the podium and also with the audience was that most investigators believe that stem cell transplant remains viable. Not only does it remain viable, it is still one of the most effective interventions that we have. It has a number of advantages that in a world where costs have become more and more important it is probably the cheapest intervention that we have. It has very few in the way of long-term toxicities and it can be administered anywhere, it doesn’t require a lot of technical sophistication and it is available in almost every country in the world. So in the worldwide view of multiple myeloma, and sometimes in the United States we tend to be, ‘This is the way we do things,’ that high dose melphalan and autologous stem cell transplant can overcome many of the absences in the presence of all drugs that parts of the world have to deal with.
So I think the consensus was that stem cell transplantation, high dose melphalan plus autologous stem cell rescue, remains a very important, a very safe and a very effective way of treating patients.