• Massimo Martino, Attilio Olivieri, Massimo Offidani, Ernesto Vigna, Tiziana Moscato, Roberta Fedele, Mauro Montanari, Giuseppe Console, Massimo Gentile, Giuseppe Messina, Giuseppe Irrera, and Fortunato Morabito.
• Oncology Department, Haematology and Bone Marrow Transplant Unit , Viale Europa, Reggio Calabria 89100, Italy. maxmartino65@alice.it
• Expert Opin Investig Drugs. 2013 May 1; 22 (5): 619-34.

IntroductionThe role of high-dose chemotherapy (HDC) followed by autologous-progenitor cell transplantation (auto-HPCT) in the treatment of multiple myeloma (MM) continues to evolve in the novel agent era. Administration of high-dose melphalan (HDM) is considered the standard conditioning regimen. Nevertheless, several attempts have recently been made to improve the conditioning phase of the HDC procedure.Areas CoveredWe reviewed all the reported experiences and illustrated current knowledge in the field of conditioning regimens.Expert OpinionFor fit MM patients, HDC followed by auto-HPCT remains the standard of care. The available data confirm that melphalan (MEL) 200 mg/m(2) should continue to be considered the gold standard conditioning regimen, with dose reduction based on age and renal function. Targeting exposure to MEL by using area under the curve is a particularly appealing approach that could be explored to maximize efficacy and minimize toxicity of this drug. Other strategies are currently being evaluated in different trials, and the most interesting areas of research involve the incorporation of newer agents like bortezomib (BOR) into conditioning regimens. Moreover, intravenous busulfan has become available and this formulation may reduce toxicity and result in greater efficacy in association with MEL-based conditioning.

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