The 23rd Annual Meeting of the International Myeloma Society (IMS) took place in Glasgow, Scotland on September 23-26, 2026. HealthTree Foundation attended the meeting and will be reporting on the latest research presented at the conference.
KEY TAKEAWAYS:
Multiple myeloma patients diagnosed today can expect to receive only two lines of therapy in their lifetime, down from five to seven before 2020. This raises the stakes on every treatment decision made early, including stem cell transplant.
The survival benefit of transplant isn’t the same for everyone. Transplant provides a real survival benefit for patients with high-risk cytogenetics but not patients with standard-risk disease.
For the first time in 30 years, autologous stem cell transplant (ASCT) has a genuine competitor: T-cell redirecting therapies. Comparing these two treatments is currently being studied in clinical trials.
ASCT remains standard of care for firstline treatment of multiple myeloma in 2026. But it comes with a real, well-documented patient burden. A HealthTree Foundation survey of multiple myeloma patients who underwent transplant found 93% reported fatigue and 71% reported diarrhea. For over half of those with fatigue, it lingered in some form after a year.
Despite the toxicity, 92% of surveyed patients said they were glad they had the transplant. And 80% said they wouldn’t do anything differently.
Among patients who chose against transplant, recovery time and drug toxicity were the top reasons, echoing doctors’ own toxicity concerns.
HealthTree registry data is already being used to determine, patient by patient, who can safely skip a transplant. This research depends on patients joining HealthTree and setting up a Personal Health Record and keeping their information current.
This article will report on what researchers at the International Myeloma Society (IMS) Annual Meeting, in Glasgow, Scotland discussed, including how patients newly diagnosed with multiple myeloma should approach stem cell transplant treatment decisions. We will also weave in HealthTree’s patient experience data to elucidate this critical topic.
“Until 2020, patients were receiving five to seven lines of therapy,” said Philippe Moreau, MD, Professor of Clinical Hematology and Head of the Hematology Department at the University Hospital of Nantes, France, and Vice-President of the International Myeloma Society. "But now, patients that are diagnosed in 2026 will receive only two lines of therapy. And we need to find — this is the first challenge — the optimal sequence, with the best frontline option and the best second-line therapy, to reach this goal of 20, 25 years of overall survival." The goal is to “get a newly diagnosed patient’s remaining lifespan back to normal, using only two treatment lines to get there.”
This means that treatment decisions about the first line of treatment are very important, including whether or not patients should get an autologous stem cell transplant (ASCT). That question was put to Aurore Perrot, MD, PhD of CHU de Toulouse, about whether or not stem cell transplant is the best frontline treatment.
Is a stem cell transplant still necessary for newly diagnosed multiple myeloma in 2026?
According to Prof. Perrot, stem cell transplants are still necessary for multiple myeloma. For now. "Today, transplant remains the standard for every eligible patient," she told the audience.
During an ASCT, a patient's own stem cells are collected. They receive high-dose chemotherapy (melphalan) to kill myeloma cells, and then the stem cells are returned to help their bone marrow recover.
Three decades of randomized trials have consistently shown that high-dose melphalan and stem cell transplant extends progression-free survival (PFS) beyond standard drug combinations alone. PFS is the amount of time after treatment before the cancer grows or changes.
The size of that benefit has grown as the drugs used alongside it have improved. In an early trial from the 1990s, we saw a 9-month gain. In the most recent 8-year follow-up of the FORTE trial (NCT02203643), there was a 29-month gain (99 months progression-free vs. 70 months without transplant).
But Perrot pointed out that every one of those trials compared transplant to the same kind of drug-based treatment. They didn’t compare transplants to a different treatment mechanism. "ASCT was tested against the same mechanisms of action, never against a new one," she said.
That is changing now that T-cell-redirecting immunotherapies, such as CAR T-cell therapy and bispecific antibodies, have been used to treat relapsed and refractory myeloma for several years. Researchers are testing these new treatments against standard of care transplant for newly diagnosed patients for the first time.
Does risk status affect how well an ASCT works to treat myeloma?
During the discussion, Perrot shared data showing that transplants aren’t a one-size-fits-all answer. Researchers pooled four randomized controlled trials to look at outcomes compared to risk status. The trials included 2,959 people. They found that the overall survival benefit from adding stem cell transplant is not the same for every patient.
For patients with high-risk cytogenetics, transplant provides a real, clinically meaningful benefit. These patients are 34% less likely to die if they get a transplant compared to those who don’t. This is based on the hazard ratio of 0.66. In comparison, for standard-risk patients, that benefit largely disappears. They are only 10% less likely to die than those who do not get a stem cell transplant. This is based on a hazard ratio of 0.90. This is close enough to 1.0, which means there is no difference between two groups.
Most patients have standard-risk disease at diagnosis. This means that the patients least likely to see a clear survival benefit from transplant are the majority of patients. The minority with high-risk cytogenetics appear to benefit the most.
Researchers are already testing this directly. The ongoing MIDAS trial (NCT04934475) is comparing transplant vs. no transplant after induction therapy for standard-risk, MRD-negative patients. So far, MRD-negativity rates have been similar in both arms at the end of consolidation. This is a signal that, for standard-risk patients, skipping transplant might not cost them depth of response. PFS data is still not available for this trial, which will help us understand better if there is any benefit to transplantation for this group. "MIDAS suggests that we could [safely drop transplant]," Perrot said, "but we do not have PFS data yet. So it is not yet proof."
Could newly diagnosed multiple myeloma patients be treated with immunotherapy first?
T-cell redirecting therapies have already had striking results for patients with relapsed myeloma.
In the CARTITUDE-4 trial, single infusion of the CAR-T therapy cilta-cel (Carvykti) produced a 30-month PFS rate of 59.4%. In comparison, the PFS was 25.7% on standard treatment.
In the MajesTEC-3 trial, the bispecific antibody teclistamab (Tecvayli) combined with daratumumab (Darzalex Faspro) produced a 36-month PFS rate of 83.4%, compared to 29.7% on standard treatment.
Early results from the MajesTEC-5 trial suggest this may extend to newly diagnosed patients, too. They show that a teclistamab-based therapy works to treat all 49 patients enrolled. Every patient evaluated was MRD-negative by the sixth treatment cycle. Perrot was careful to caveat this: “These first-line data are small, non-randomized, with a short follow-up.” The ongoing randomized, head-to-head trials, will prove whether these immunotherapies are better than ASCT.
This question is reshaping myeloma care in 2026. Should frontline treatment for newly diagnosed patients be built around transplant, around T-cell redirection, or some combination of both? And for which patients?
Which clinical trials are testing this question now?
Five randomized, first-line trials are now directly comparing stem cell transplant to T-cell-redirecting therapy. This is the first time in myeloma research that transplant has been tested head-to-head against a genuinely different treatment mechanism, in newly diagnosed patients.
Name | Status | Details |
|---|---|---|
CARTITUDE-6/EMagine (EMN28): NCT0525708 | Complete | This complete trial compared Dara-VRd induction followed by cilta-cel (CAR-T) vs. Dara-VRd followed by transplant. |
ELLEN (IFM2025-01) NCT06918002 | Recruiting (Target enrollment: 824 patients) | This clinical trial is studying Dara-VRd followed by elranatamab plus lenalidomide without transplant vs. Dara-VRd, transplant, and consolidation. |
TRIlogy-6 (EMN41) NCT07665450 | Not yet open (Target enrollment: 1,000 patients) | A tri-specific antibody targeting BCMA, GPRC5D, and CD3, plus daratumumab, vs. Dara-VRd, transplant, consolidation, and maintenance. |
DURGA-6 NCT06235229 | Recruiting (Target enrollment: 750 patients) | A dual-targeting BCMA/CD19 CAR-T therapy vs. transplant, both following induction therapy. |
iMMagine-6 | Not yet open | Anti-CD38-based induction followed by the CAR-T therapy anito-cel vs. induction, transplant, and maintenance. |
A sixth trial, MIDAS (NCT04934475), is separately testing whether standard-risk, MRD-negative patients can skip transplant altogether after induction (see above).
Considering a clinical trial as a newly diagnosed multiple myeloma patient
For a newly diagnosed patient, this may be the single most useful takeaway from IMS 2026. The question of whether transplant, immunotherapy, or both is right for a given patient is genuinely unresolved. The trials above are what will resolve it. That makes this a good time to enroll in a frontline clinical trial, for a few concrete reasons:
Rigorous baseline testing is built in. Every one of these trials requires standardized cytogenetic risk testing and MRD assessment as part of the protocol. This is the data Perrot says the field needs to determine "which patient needs what." In HealthTree's broader work with patients and their records, testing this consistently isn't always the norm outside of a trial setting. Enrolling in a trial is one of the most reliable ways to make sure it happens for you.
Access to the newest treatment options, years before broad approval. T-cell-redirecting therapies are currently approved only for relapsed disease. These trials are the only way for most newly diagnosed patients to access them as a frontline option today.
Your outcome helps answer the question for the next patient. First-line evidence for these approaches is still thin. Every enrolled patient meaningfully moves the field's understanding of who truly needs a transplant.
If you or your loved one is newly diagnosed with multiple myeloma, ask your care team directly whether you're eligible for any of the trials above, or search ongoing frontline myeloma trials through HealthTree's clinical trial finder.
What are patients at HealthTree saying about the real cost of their ASCT?
The clinical trial data presented at IMS explains why this debate is happening. But for a patient actually facing the decision, the more immediate question is what a transplant is actually like to experience. HealthTree has one of the largest patient-reported datasets available, including a survey of hundreds of multiple myeloma patients who have lived through stem cell transplant.
What is the experience of a stem cell transplant actually like for patients?
Perrot was direct about the cost of high-dose melphalan and transplant. Side effects and outcomes like mucositis, low blood counts (cytopenias), hospitalization, and a small but real risk of second cancers later in life have a big impact.
HealthTree’s own survey of multiple myeloma patients who have gone through stem cell transplant puts numbers behind that toxicity. There were 336 patients who answered the question on toxicity. They experienced:
Fatigue (93%)
Diarrhea (71%)
Nausea and/or vomiting (57%)
Digestive issues (46%)
Brain fog (46%)
Sleep difficulties (30%)
Depression or anxiety (19%)
Mouth sores (19%)
Infection (16%)
The upfront ordeal alone is substantial. Most patients spent one to four weeks hospitalized for chemotherapy and stem cell reinfusion itself (76%). Of those, 39% were away from home for three to four weeks and 29% for one to two weeks.
Many patients also experience long-term side effects. Among those reporting fatigue, 55% said they still experienced some fatigue more than a year after transplant and 5% still found it disruptive to daily life. Among those reporting brain fog, 58% still experienced it more than a year later and 8% found it disruptive.
How long does transplant recovery really take?
Recovery overall is not quick. Among the roughly 300 to 330 patients who answered HealthTree's detailed recovery-timeline questions, the single most common answer for regaining pre-transplant physical strength was more than 12 months (24% of applicable respondents). For feeling "100% recovered," more than a third of patients (34%) said it took over a year.
Needing a caregiver resolved faster for most. The most common answer was three to four weeks (27%), but returning to work or similar responsibilities most commonly took three to four months among those who went back (32%). About a quarter (24%) of all respondents said the question didn’t apply to them, most likely because they weren’t working before the diagnosis. And a quarter (25%) avoided crowds and large gatherings for three to four months after transplant.
About a third of patients (33%) said the experience was about what they expected going in. But among the rest, more found it harder than expected (30%) than easier (27%). This is a real gap given how patients feel walking in.
In a formally presented analysis of HealthTree's stem cell transplant survey data at the 2025 Tandem Meetings (the joint meeting of the American Society for Transplantation and Cellular Therapy and CIBMTR), researchers directly compared patients' expectations going in against what they actually experienced.
Four of the five recovery milestones measured took longer than patients expected, and the gaps were statistically significant. Regaining pre-transplant strength took 8.8 weeks longer than anticipated on average (18.4 weeks expected vs. 27.2 weeks experienced, p < 0.0001), returning to work took 2.6 weeks longer than expected (p < 0.05), and returning to crowds or large gatherings took 6.7 weeks longer than expected (p < 0.001). The one bright spot: needing a caregiver actually resolved 1.4 weeks faster than patients expected (p < 0.05).
Do people with multiple myeloma regret having a stem cell transplant?
Most respondents did not regret their transplant, but it was not unanimous. HealthTree found:
92% of patients said they were glad they had the transplant
80% said they wouldn’t do anything differently
78% said their doctor actively encouraged the transplant
4% said they felt pressured into it
1% said it was not discussed as optional
That leaves 20% of patients who would have made a different choice. While it is a minority of patients, it’s a population that is often left out of the “transplant works, full stop” narrative. HealthTree’s survey also captured open-ended reflections from these patients describing harder-than-expected recoveries and, in some cases, lasting regret about the decision.
Why do some patients with multiple myeloma decide against a transplant?
A smaller group of surveyed patients opted out of transplant altogether or delayed it. Their stated reasons line up almost exactly with the toxicity concerns Perrot raised at IMS 2026. Among 64 patients who described their reasons for opting against transplant at the time, the most commonly cited factors were:
Total recovery time (53%)
Toxicity of the drugs (e.g., melphalan; 52%)
It was simply too harsh physically (48%)
Length of time it would take to regain their strength (45%)
Other treatment options presented with equal or better efficacy (41%)
Risk of secondary cancers (27%)
In other words, when hematologists say "most want to avoid transplant due to toxicity," HealthTree's patient data suggests many patients are weighing the exact same trade-off themselves.
Putting myeloma patient data to work
The survey data above exists because patients chose to share their experiences. That data is already being used by researchers to better understand the patient experience.
In a study accepted for presentation at ASCO 2026, HealthTree Foundation researchers and physicians from the Sylvester Myeloma Institute at the University of Miami analyzed 212 newly diagnosed patients from the HealthTree registry to test whether an AI-based biomarker, read directly from routine bone marrow biopsy slides, could identify which patients could safely skip transplant.
The results were striking. Among patients treated with daratumumab-based quadruplet therapy, those with high "immune fitness" did just as well without a transplant as with one. Immune fitness was measured via an AI-predicted marker called CD16. Of those, 86.3% were progression free at 18 months without transplant, compared to 82.2% with transplant. This difference was not statistically significant.
Patients with low immune fitness, by contrast, needed either transplant or the daratumumab-based regimen to avoid early progression. In short, the same "which patient needs what" question Perrot posed on stage at IMS 2026 is already being answered, patient by patient, using real HealthTree registry data.
That kind of research is only possible because patients keep their information current and connected. If you're a multiple myeloma patient, creating a Personal Health Record with HealthTree and keeping your treatment history, side effects, and outcomes up to date directly contributes to studies like this one, which are actively reshaping how doctors decide who truly needs a transplant.
The bottom line: personalized treatment options are the future of myeloma care
Moreau's framing at the top of this story is the reason all of this matters: a myeloma patient diagnosed in 2026 may only get two lines of therapy in which to get this right. Perrot's answer to "ASCT, yes or no?" is neither: "The future is not transplant or no transplant. The future is which patient needs what."
Until the five trials above read out, that answer is still being written. And patients who enroll in a frontline trial, or who keep their HealthTree registry profile current, are the ones actually writing it.
About the Experts
Philippe Moreau, MD — Professor of Clinical Hematology and Head of the Hematology Department, University Hospital of Nantes, France. Vice-President of the International Myeloma Society since 2019. Steering committee member of the International Myeloma Working Group since 2013.
Aurore Perrot, MD, PhD — Professor, Hematology Department, CHU de Toulouse. Heads the clinical research program on multiple myeloma at the Toulouse Cancer Institute (IUCT-Oncopole).
Jay Hydren, PhD — Author of this article, HealthTree Foundation. Senior/Co-author of the HealthTree registry and survey research cited above, including the ASCO 2026 abstract on AI-predicted NK-cell fitness in transplant decision-making and the 2025 Tandem Meetings abstract on stem cell transplant recovery expectations.
Methodology note: Patient-reported statistics in this article are drawn directly from BigQuery-hosted response data for HealthTree Foundation's "Understanding Multiple Myeloma Stem Cell Transplant Experiences" survey, and from a separate, formally presented analysis of that same survey data ("Bridging Expectation and Reality: Recovery Patterns and Peer Learning After SCT in Multiple Myeloma," Hydren et al., 2025 Tandem Meetings, n=107). Per-question response counts for the BigQuery data ranged from 64 (reasons for opting against transplant) to 430 (current transplant status), varying by question and excluding "Does Not Apply"/"I don't know" responses where noted. The registry-based precision-medicine research is drawn from "Artificial Intelligence Predicted Natural Killer Cell Fitness Guides Daratumumab and Transplant Strategies in Newly Diagnosed Multiple Myeloma" (Rajanna, Hurtado Martínez, Hydren, et al., ASCO 2026 Abstract #7520, n=212 HealthTree registry patients). Clinical trial and expert commentary are drawn from Prof. Aurore Perrot's presentation "What is the role today and in the near future of ASCT?" at the 23rd International Myeloma Society Annual Meeting, Glasgow, Scotland, Sept. 23, 2026, including her recorded Q&A exchange, and from Prof. Philippe Moreau's remarks earlier in the same session.
