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Should Routine Stem Cell Transplantation Be Discontinued in Newly Diagnosed Patients With Myeloma?

By: Joshua Swore, PhD
Posted: Wednesday, November 16, 2022

Research presented at the 2022 International Myeloma Society (IMS) Annual Meeting and Exposition (Abstract P-216) makes a case for discontinuing the routine use of early stem cell transplantation in newly diagnosed patients with multiple myeloma. According to Brittany Miles, MD, of The University of Texas Medical Branch, Galveston, and James Mackey, MD, of GenesisCare, “stopping and restarting these agents to facilitate a stem cell transplant may result in the creation of treatment resistance in a fashion similar to the stopping and restarting of chemotherapy for solid tumors. It may be most appropriate to reserve stem cell transplantation for patients who do not achieve minimal residual disease negativity by a time frame that has yet to be determined, or if maximal response with first-line therapy does not result in minimal residual disease negativity.”

The retrospective study used patient-associated data from the TriNetX federated global database. A total of 26,036 patients who had received a multiple myeloma diagnosis within the past 5 years were placed into each cohort based on whether they had received stem cell transplantation or not. Both cohorts possessed similar age, race, gender, and ethnicity demographics.

The authors reported that patients who received early stem cell treatment had a 3.2 risk ratio for relapse (95% confidence interval 3.07–3.36). Furthermore, patients receiving early stem cell treatment had a 5-year overall survival rate of 60.8%, whereas patients who did not receive stem cell transplantation had a 5-year overall survival rate of 84.3%. These results led the authors to conclude that it might be sound thinking to discontinue routine stem cell transplantation for newly diagnosed patients with multiple myeloma, because in the era of novel agents, it offers little benefit and may put patients at risk for relapse.

Disclosure: No authors’ disclosures were provided.

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