Bone marrow transplantation has become an accepted and important medical intervention and a routine part of medical practice. However, its utility in a number of diseases has been questioned recently on the basis that there are better nontransplant therapeutic options. The question of whether these moves to eradicate bone marrow transplantation as an option stem from purely scientific reasons has been raised [1]. Front-line treatment of high-dose melphalan and autologous stem cell transplantation (ASCT) has improved the prognosis of patients with multiple myeloma (MM). We and others have shown that the cost-benefit ratio of ASCT as front-line treatment for patients with MM is considerably better than that of front-line treatment with novel antimyeloma drugs [2], and this observation is particularly critical in underprivileged circumstances. On the other hand, the capability to carry out ASCT procedures in MM on an outpatient basis has resulted in substantial decreases in the cost of autografting patients with this disease [3, 4]. The paper by Muta et al. [5] in the last issue of Acta Haematologica supports the role of ASCT as a salvage treatment for patients with relapsed MM, in turn supporting the usefulness of this procedure in another setting of the disease.

In an era when research on the treatment of patients with MM relies mainly and dangerously on the assessment of novel, extremely expensive antimyeloma drugs such as the new proteasome inhibitors, IMID and monoclonal antibodies, this type of refreshing paper is welcome indeed; the benefit of the patients was and should always be considered over other non-strictly scientific or ethical reasons in therapeutic choices for individuals with MM [6]. The observation made in a well-developed country such as Japan might turn out to be even more useful in circumstances of economic restraint.

1.
Ruiz-Arguelles GJ: Whither the bone marrow transplant. Hematology 2010; 15: 1–3.
2.
López-Otero A, Ruiz-Delgado GJ, Ruiz-Argüelles GJ: A simplified method for stem cell autografting in multiple myeloma: a single institution experience. Bone Marrow Transplant 2009; 44: 715–719.
3.
Karduss-Urueta A, Ruiz-Argüelles GJ, Perez R, Ruiz-Delgado GJ, Cardona AM, Labastida-Mercado N, Gómez LR, Galindo-Becerra S, Reyes P, Alejo-Jiménez J: Cell-freezing devices are not strictly needed to start an autologous hematopoietic transplantation program: non-cryopreserved peripheral blood stem cells can be used to restore hematopoiesis after high dose chemotherapy – a multicenter experience in 268 autografts in patients with multiple myeloma or lymphoma. Study on behalf of the Latin-American Bone Marrow Transplantation Group (LABMT). Blood 2014,124: 849.
4.
Gale RP, Ruiz-Argüelles GJ: The big freeze may be over. Bone Marrow Transplant, in press.
5.
Muta T, Miyamoto T, Kamimura T, Kanda Y, Nohgawa M, Ueda Y, Iwato K, Sasaki O, Mori T, Uchida N, Iida S, Fukuda T, Atsuta Y, Sunami K: Significance of salvage autologous stem cell transplantation for relapsed multiple myeloma: a nationwide retrospective study in Japan. Acta Haematol 2018; 139: 35–44.
6.
Ruiz-Argüelles GJ, Steensma DP: Staunching the rising costs of haematological health care. Lancet Haematol 2016; 3: 10.
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