A single autologous transplant is considered medically necessary for mulitple myeloma. I was only able to find one fairly dated report of two patients treated with a third autologous transplant.
NCCN advises allogeneic transplant on a clinical trial after relapse from an autologous transplant. It says that allogneic transplant includes the non-myeloablative form. Underlying this recommendation is lack of studies that compare this aproach to salvage chemotherapy alone, especially since availability of Revlimid and Velcade.
One guideline that address a situation similar to this patient are the Dutch guidelines say the following: These include upfront induction therapy followed by autologous transplantation for patients aged up to 65 years and oral melphalanprednisone treatment for patients with severe co-morbidities and patients over the age of 65 years. Patients under the age of 66 with an HLA-identical (family) donor are candidates for non-myeloablative stem-cell transplantation following autologous stem-cell transplantation. For second-line treatment, thalidomide, combined with dexamethasone is recommended. Younger patients responding to second-line treatment are candidates for a second autologous transplant. Bortezomib is indicated for those patients refractory to the previous two lines of treatment. All patients should receive long-term bisphosphonates.”
NCCN does allow an option of a repeat autologous transplant for salvage on p. MYEL-5 and recommends considering the time between transplants and documented progression.
Most transplant centers would do an allogeneic transplant for patients relapsing after an autologous transplant.
Jourdan E, Blaise D, Fegueux N, Navarro R, Rossi JF, Maraninchi D, Navarro M.Third autologous stem cell transplants for late relapse of multiple myeloma.Bone Marrow Transplant. 1996 May;17(5):885-6
NCCN – http://www.nccn.org/professionals/physician_gls/PDF/myeloma.pdf
J Mehta et al, Salvage autologous or allogeneic transplantation for multiple myeloma refractory to or relapsing after a first-line autograft? Bone Marrow Transplantation May 1998, Volume 21, Number 9, Pages 887-892
Lokhorst H, Huijgens PC, Raymakers R, Bos GM, Vellenga E, Wijermans PW, Sonneveld PModern treatment methods for multiple myeloma: guidelines from the Dutch Haemato-Oncology Association (HOVON), Ned Tijdschr Geneeskd. 2005 Apr 9;149(15):808-13.