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Does Intensive Therapy Improve Survival in Patients With Multiple Myeloma?

By: Sarah Campen, PharmD
Posted: Tuesday, February 19, 2019

A clinical trial published in the Journal of Clinical Oncology revealed that more intensive approaches did not improve survival in patients with multiple myeloma compared with those the standard treatment of high-dose melphalan and autologous hematopoietic cell transplantation (AHCT). “Single AHCT followed by lenalidomide remains the standard of care,” stated Edward A. Stadtmauer, MD, of the Perelman Center for Advanced Medicine at the University of Pennsylvania, Philadelphia, and colleagues. “Greater than 80% of patients were alive at 38 months, which highlights excellent contemporary outcomes of patients with [multiple myeloma] when treated with a standard approach of a multidrug induction followed by AHCT consolidation and maintenance.”

The phase III study included 758 patients with active multiple myeloma who had received initial therapy without disease progression. All participants received high-dose melphalan and then were randomly assigned to 1 of 3 arms: tandem AHCT plus lenalidomide maintenance (n = 247), AHCT plus 4 cycles of lenalidomide, bortezomib, and dexamethasone followed by lenalidomide maintenance (n = 254), and AHCT and lenalidomide maintenance alone (n = 257). The 38-month progression-free survival rates were 58.5%, 57.8%, and 53.9%, respectively; overall survival rates were 81.8%, 85.4%, and 83.7%, respectively.

As for safety, the rates of toxicity and development of second primary malignancies were similar across treatment arms. In the first year after transplantation, a higher number of infections were observed in the tandem AHCT arm.

Disclosure: The study authors’ disclosure information may be found at ascopubs.org.



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