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ASH 2017: ASCT Versus Three-Drug Combination in Newly Diagnosed Multiple Myeloma

By: Celeste L. Dixon
Posted: Monday, December 18, 2017

The second interim analysis of a large European multiple myeloma trial, EMN02/HO95, showed autologous stem cell transplantation (ASCT) plus high-dose intensification melphalan resulted in 24% longer progression-free survival than standard-dose intensification treatment with bortezomib, melphalan, and prednisone (VMP). Also, this study revealed for the first time that with ASCT, overall survival rates were prolonged in certain subgroups of patients with a poor prognosis.

Investigated by a multinational team, more than 1000 patients newly diagnosed with multiple myeloma, 65 years or younger, received 3 to 4 cycles of bortezomib-based induction therapy followed by peripheral blood stem cell collection. Then they were randomized to the ASCT arm (695 patients) or the VMP arm (497 patients). In each arm, 25% of patients had a high-risk cytogenic profile.

Lead author Michele Cavo, MD, of the Bologna University School of Medicine in Italy, presented this analysis at the 2017 American Society of Hematology (ASH) Annual Meeting & Exposition (Abstract 397). She noted that compared with VMP, “High-dose intensification melphalan plus ASCT significantly increased the rate of high-quality responses, ultimately leading to improved progression-free survival.” This held true for patients classified as both standard-risk and high-risk in predefined subgroups.

On an intention-to-treat basis, the 3-year progression-free survival estimate was 64% for the ASCT arm and 57% for the VMP arm, translating to a 24% reduced risk of progression or death with ASCT.