In transplant-eligible, fit patients with primary refractory myeloma, what is the optimal timing for stem cell collection?   

In fit patients with less than a partial response to induction therapy, i.e. primary refractory, the optimal timing for stem cell collection is NEVER. If they don't respond to three drug induction (proteasome inhibitor + IMiD + steroid), they are unlikely to respond durably to a standard high dose ...

I will take a different tactic in these primary refractory disease cases. I typically employ a VD-PACE like regimen and give for 2 cycles. Then use the second cycle as part of chemomobilization for stem cell collection, followed by high dose melphalan and stem cell rescue. After transplant, I then ...

Adding an updated response as requested by theMednet editorial team :) I agree with everything in @Craig C. Hofmeister's response from 3 years ago. For patients with primary refractory myeloma, even collecting stem cells is probably low-yield especially since it's not benign. And while continued len...