High-Dose Therapy Followed by Autologous Stem Cell Transplant for Multiple Myeloma
High-dose therapy with melphalan followed by autologous stem cell transplant (HDT/ASCT) for patients with multiple myeloma was associated with superior progression-free survival than standard-dose therapy but no significant difference in overall survival, according to a meta-analysis of phase III trials published in JAMA Oncology. Thus, for Binod Dhakal, MD, MS, of the Medical College of Wisconsin, and colleagues, ASCT remains the preferred therapy for transplant-eligible patients with myeloma.
For the review, 4 randomized clinical trials involving a total of 2,421 patients were included in the conventional meta-analysis; they compared HDT/ASCT with standard-dose therapy using novel agents. In addition, 5 randomized clinical trials (3,171 patients) comparing single HDT-ASCT with bortezomib, lenalidomide, and dexamethasone (VRD) consolidation and tandem transplantation were selected for network meta-analysis.
When compared with standard-dose therapy, HDT/ASCT yielded a combined odds for complete response of 1.27. The progression-free survival also seemed to favor HDT, with a combined hazard ratio of 0.55; however, a significant difference in overall survival was not shown, with similar overall survival across the four approaches. Dr. Dhakal and colleagues also found that tandem HDT/ASCT and single HDT/ASCT plus VRD were associated with better progression-free survival than single HDT/ASCT alone.
“Longer follow-up may better delineate any overall survival benefit; however, it is likely to be affected by effective postrelapse therapy,” the investigators noted.