Multiple Myeloma (MM) is a common blood cancer affects which accounts for 1.2% of cancers in India. The standard treatment for newly diagnosed patients with myeloma who can receive a transplant includes a combination of multiple medicines like Bortezomib, Lenalidomide, and Dexamethasone (VRd) with/without Daratumumab followed by stem-cell transplant and Lenalidomide maintenance.

Transplant is a process which is commonly done after few cycles of chemotherapy when the cancer comes under control. For transplant, high doses of a chemotherapy medicine called melphalan is used. The standard dose of melphalan used for transplant is 200 mg/m², but a lower dose of 140 mg/m² is used for patients who are perceived to be at higher risk of complications. In today’s era, for assessing how much a cancer has come under control – a special test called minimal residual disease (MRD) is used. MRD means the least amount of cancer cells which are present in a patient’s body. It is known that in myeloma, patients who become MRD negative for their cancer have a better outcome in long run in contrast to others. This concept is similar to other blood cancers (like acute lymphoblastic leukemia) wherein MRD carries a lot of significance. The standard dose of melphalan was established two decades back when special tests like MRD were not available. In our practice, we have been doing MRD prior to transplant in all our myeloma patients who undergo transplant. Melphalan doses are reduced depending on patient’s clinical condition and organ functions prior to transplant. There is limited data comparing the outcomes of standard versus lower doses of melphalan, especially in today’s MRD era. We will address the above question in this prospective randomised study.