ASH 2018: Double vs. Single Autologous Transplantation in Newly Diagnosed Myeloma
Posted: Friday, December 7, 2018
Compared with single autologous stem cell transplantation (ASCR-1), double autologous transplantation (ASCT-2) appears to superior for patients newly diagnosed with multiple myeloma, according to a pooled analysis of randomized phase III trials. This benefit with ASCT-2 seems to be particularly pronounced in those identified as at high risk (due to advanced International Staging System stage, adverse cytogenetics, and failure to achieve complete response). Michele Cavo, MD, of the Seragnoli Institute of Hematology and Medical Oncology, Bologna, Italy, and colleagues presented their data at the 2018 American Society of Hematology (ASH) Annual Meeting & Exposition (Abstract 124).
The long-term follow-up analysis of patient-level data from 909 patients focused on 3 phase III trials of bortezomib/thalidomide/dexamethasone or bortezomib/doxorubicin/dexamethasone. These induction regimens were given prior to ASCT; then after ASCT, bortezomib-based consolidation and/or maintenance treatment was given.
After a median of 117 months, patients who were given ASCT-2 had higher progression free survival (47 months) than those given ASCT-1 (38 months). The 1-year overall survival probability with ASCT-2 was 58%, compared with 47% with ASCT-1.
Patients were then divided into three subgroups, which were identified as low-risk, intermediate-risk, and high-risk based on staging, high-risk cytogenetics, and failure to achieve best complete response. Those in the high-risk group saw a prolonged progression-free survival with ASCT-2 treatment (32 months) in comparison to the ASCT-1 treatment (20 months). An ultra–high-risk subset of patients saw a 2-fold increase in progression-free survival with ASCT-2 than with ASCT-1 (35 months vs. 14 months). In addition, 10-year overall survival rates were better in those with standard-risk cytogenetics than in those with high-risk cytogenetics (72% vs. 60%). The 10-year overall survival rates in those with high-risk cytogenetics also favored ASCT-2 over ASCT-1 (51% vs. 34%).