Answering the Transplant Question for Newly Diagnosed Patients - The FASTER Study

For three decades, a stem cell transplant has been a standard part of care for newly diagnosed myeloma patients who are eligible for one. But with powerful immunotherapies moving earlier into treatment, a question patients ask us constantly is finally being put to the test: is transplant still necessary?
Dr. Timothy Schmidt of the University of Wisconsin joins us to discuss FASTER, a COMMIT consortium trial he co-chairs. After induction therapy, FASTER randomly assigns patients to either a bispecific antibody combination — elranatamab plus daratumumab — or to transplant followed by standard maintenance. MRD testing then guides what happens next. Patients with disease still detectable after a year cross over to the other approach, and patients who reach sustained MRD negativity may be able to stop treatment entirely and simply be watched.
We talk about what transplant really asks of a patient, who might still need one, how bispecific antibodies work, infection risk and how it's managed, and what it means to stop myeloma treatment after years of being told maintenance continues indefinitely.

For three decades, a stem cell transplant has been standard for newly diagnosed myeloma patients healthy enough to have one. Dr. Timothy Schmidt of the University of Wisconsin joins us to discuss FASTER, a CoMMit Consortium trial he co-chairs that asks the question patients ask us constantly: with immunotherapies this effective, do I still need a transplant? After four to six months of standard quadruplet induction, patients are randomly assigned to either elranatamab plus daratumumab or to transplant followed by standard maintenance. At fifteen months, MRD testing decides what comes next. Patients with disease still detectable cross over to the other approach, giving all patient the opportunity to get all therapies. Those who reach MRD negativity on two consecutive bone marrows stop treatment altogether and are simply watched.

Dr. Schmidt walks through what being on a bispecific antibody actually involves — step-up dosing, cytokine release syndrome and how it is managed, and why IVIG and preventive antibiotics matter so much — along with a recent amendment that stretches second-year dosing to once every twelve weeks. FASTER is a 100-patient phase 2 study at ten centers, roughly 75 patients have enrolled, and enrollment remains open in Nashville, Denver, Norfolk, Madison, Milwaukee, Iowa City, Birmingham, Chapel Hill, Columbus and Dallas.