Algorithm of clinical and laboratory follow-up in patients with multiple myeloma during the autologous hematopoietic stem cell transplantation

The significant advances in the treatment of multiple myeloma (MM) noted in recent years are the result of a number of factors. Among them may be highlighted: the use of multicomponent therapy regimens in clinical practice, including target drugs; autologous hematopoietic stem cell transplantation (HSCT), as a standard of consolidating therapeutic option for candidates for high-dose chemotherapy; the appointment of maintenance therapy, which intensity and duration may vary depending on the biological phenotype of MM and the extent of the residual disease. However, MM remains an incurable disease. When choosing a therapeutic option, clinicians are guided by the necessity to achieve these two goals: 1) to achieve a sustained negative status of minimal residual disease (MRD), which leads to a greater rate of a sustained clinical response, longer progression-free survival (PFS) and overall survival (OS); 2) to provide the optimal quality of life (QoL) status for a particular patient, followed by its preservation for the longer period of time. The efficacy of every stage during the therapy of MM is an essential condition for the achievement of an acceptable response to treatment. Thus, the efficacy of autologous HSCT is an integral indicator that includes the following factors: the response to previous therapy; the intensity of the conditioning regimen and the optimal number of transfused CD34+ hematopoietic stem cells (HSC), complications of HSCT. A number of additional factors also may affect the efficacy of autologous HSCT. These factors include the characteristics of the amount of HSC (graft), the effect of the intestinal microbiota with the dynamics of its changes during treatment, and the genetic profile of MM. Successful HSCT facilitates the timely transition to the next stage of MM therapy. The aim of the study was to develop an algorithm for the clinical and laboratory monitoring of patients with MM during HSCT.