A Mixed-Methods Study of Stem Cell Transplantation Utilization for Newly Diagnosed Multiple Myeloma

Background: Current guidelines recommend that autologous hematopoietic stem cell transplantation (AHSCT) be considered for all eligible patients with multiple myeloma during first-line treatment. However, less than one-third of patients in the United States undergo the procedure. The reasons for this are unclear. Patients and Methods: We performed a mixed-methods study including qualitative interviews of patients who declined AHSCT at a high-volume regional transplantation center. Results: Over a 12-month period, 63% (129/206) of patients underwent AHSCT during first-line therapy. The consulting physician deemed 26% (47) ineligible. An additional 11% (23) were eligible but declined. In the qualitative interviews, 3 themes emerged regarding AHSCT refusal: (1) possible toxicity and disruption in quality of life; (2) unclear gains of AHSCT versus standard chemotherapy; and (3) the sense that transplantation was not suggested for them specifically, rather it was “the routine”; we coined this theme “impersonalized medicine.” Conclusion: On the basis of our findings, we stress the importance of providers helping patients weigh the respective benefits and outcomes of AHSCT and non-AHSCT treatment approaches during the clinical encounter, a key tenet of shared decision-making.