Multiple Myeloma Coverage from Every Angle

Combination Treatment With or Without Transplantation in Multiple Myeloma

By: Cordi Craig
Posted: Thursday, August 31, 2017

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.”

By continuing to browse this site you permit us and our partners to place identification cookies on your browser and agree to our use of cookies to identify you for marketing. Read our Privacy Policy to learn more.