Autologous Stem Cell Transplantation for Plasma Cell Dyscrasias in India: Clinical Characteristics, Outcomes and Relapse Predictors.

Autologous stem cell transplantation (ASCT) remains a cornerstone in the management of plasma cell dyscrasias, particularly in younger patients, despite advancements in novel therapeutic agents. However, real-world outcomes in resource-limited settings like India remain underreported. We conducted a single-center, retrospective analysis of 67 patients with plasma cell dyscrasias who underwent ASCT between December 2012 and October 2024 at a tertiary care center in Northern India. Clinical characteristics, induction regimens, transplantation details, and outcomes were evaluated. Relapse-free survival (RFS) and overall survival (OS) were calculated using Kaplan-Meier analysis, and risk factors for relapse were identified through logistic regression. The median patient age was 50 years, with a male predominance (73.1%). Multiple myeloma accounted for 88.1% of cases. Induction regimens varied, with CyBorDex being most common. Median time to neutrophil and platelet engraftment was 10 and 12 days, respectively. Febrile neutropenia occurred in 68.9% of patients, and 30-day transplant-related mortality was 7.5%. At a median follow-up of 4 years, the 5-year OS and RFS were 74.5% and 53%, respectively. High-risk cytogenetics and positive day 100 PET-CT showed trend towards higher risk of relapse. ASCT remains effective in improving survival and deepening response in plasma cell dyscrasias, even in resource-constrained settings. Relapse rates and transplant-related mortality are higher than Western cohorts, underscoring the need for improved supportive care and broader access to maintenance therapies in India.