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Prashant Kapoor, MD, FACP


Does the Addition of Upfront Autologous HSCT Improve Outcomes in Patients With Multiple Myeloma?

By: Joshua D. Madera, MS
Posted: Friday, March 10, 2023

For patients with newly diagnosed multiple myeloma, the addition of autologous hematopoietic stem cell transplantation (HSCT) to bortezomib-based induction slightly improved progression-free survival and may be a potential treatment strategy, according to the results of the phase II CARDAMON trial, published in The Lancet Haematology. However, additional investigative efforts are warranted to further elucidate the benefits of this combined treatment modality, suggested Kwee Yong, PhD, of the University College of London Cancer Institute, and colleagues.

“Current risk-stratified trials should also aim to identify patients who benefit from autologous HSCT and the optimal postautologous HSCT therapy needed to maintain disease response,” suggested the study authors.

From 2015 to 2019, a total of 281 patients with transplantation-eligible multiple myeloma were included in the study. All patients were administered four cycles of combination therapy with 56 mg/m2 of intravenous carfilzomib, 500 mg of cyclophosphamide, and 40 mg of dexamethasone (KCd). Patients who were at least partially responsive to this therapy (n = 218), as determined by peripheral blood stem cell mobilization, were randomly assigned to receive high-dose melphalan (n = 109) or HSCT (n = 109). All patients also received 18 cycles of maintenance therapy with carfilzomib on days 1, 8, and 15.

The study findings revealed that the progression-free survival rate exceeded the noninferiority margin, with observed rates of 75% in the HSCT group and 68% in the KCd group. In addition, 57.7% of patients demonstrated a very good partial response after induction therapy. Common adverse effects associated with KCd induction and consolidation included lymphocytopenia and infection. Moreover, carfilzomib maintenance therapy–related adverse effects included infection (16% KCd vs. 25% HSCT) and hypertension (21% vs. 23%).

Disclosure: For full disclosures of the study authors, visit

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