Combination Treatment With or Without Transplantation in Multiple Myeloma
The standard treatment for adults with multiple myeloma has been high-dose chemotherapy followed by stem cell transplantation. However, a new study by Michel Attal, MD, of the Institut Universitaire du Cancer de Toulouse-Oncopolem, and colleagues demonstrated efficacy for a combination treatment of lenalidomide, bortezomib, and dexamethasone (RVD) plus stem cell transplantation. The findings, published in The New England Journal of Medicine, showed significantly longer progression-free survival with RVD therapy plus transplantation than with RVD therapy alone, but there was no significant difference in overall survival between the two groups.
In this open-label, randomized trial, 700 patients with multiple myeloma (under 65 years old) across 69 sites were placed into 2 groups. Both groups received induction therapy of RVD; then they were given distinct consolidation therapies of additional cycles of RVD (n=350) or high-dose melphalan plus stem cell transplantation (n=350).
In the group that underwent transplantation, median progression-free survival was significantly longer (50 months vs. 36 months in the group that received RVD alone; P<.001).
A significantly greater percentage of grade 3 or 4 adverse events occurred in the transplant group than in the RVD-alone group; they included neutropenia (92% vs. 47%), gastrointestinal disorders (28% vs. 7%), and infections (20% vs. 9%). Treatment-related death occurred in six versus two patients, respectively.
The investigators noted: “[The progression-free survival] benefit must be weighed against the increased risk of toxic effects associated with high-dose chemotherapy plus transplantation.”