Tandem Transplant Strategies Associated With Higher Progression-Free Survival in Patients With Multiple Myeloma

Several treatments are available for multiple myeloma: autologous hematopoietic stem cell transplantation (auto-HSCT), allogeneic (allo-HSCT), tandem auto-HSCT, or auto-allo-HSCT approaches. Although auto-HSCT remains the gold standard of treatment, there is no clear consensus on the advantages and/or disadvantages of each approach. In a retrospective analysis presented at the 61st American Society of Hematology (ASH) Annual Meeting & Exposition, held in Orlando, Florida, researchers compared various multiple myeloma treatment approaches to help guide clinicians in choosing the best treatment option.

The study included 24,936 patients who underwent auto-HSCT, 3683 patients who then proceeded to undergo an elective tandem auto-HSCT, and 878 patients who underwent an auto-allo-HSCT. The authors compared the results of each treatment using landmark analysis, and 2 dynamic prediction models to predict long term outcomes while adjusting for possible information loss during landmark analysis. A third model accounted for the long-term effect of undergoing tandem treatments at different times.

Approximately 18% of patients were in complete remission after the first auto-HSCT. “Younger age and being in clinical remission at first transplant were consistently found to be positive prognostic factors for progression-free survival and overall survival,” noted the study authors. Patients who sought a tandem auto or auto-allo treatment were less likely to achieve complete remission (9% and 8% of patients, respectively).

Tandem treatment, both auto-auto and auto-allo, resulted in superior progression-free survival compared with single auto-HSCT treatment. Patients in tandem treatment groups also had slightly superior overall survival rates. Tandem auto-HSCT treatment was especially valuable for patients who were in clinical remission after the first auto-HSCT treatment for both progression-free survival and overall survival. Altogether, tandem auto-allo was superior to both single and tandem auto-HSCT in long-term progression free survival. However, the authors caution that this advantage translated to only a minor advantage in overall survival.

Disclosure: Multiple authors declared affiliations with industry. Please refer to the original abstract for a full list of disclosures.

Reference

Schönland SO, IacobelliS, KosterL, et al. Comparison of different upfront transplant strategies in multiple myeloma — a large registry study from chronic malignancies working party of EBMT. Oral presentation at: 61st ASH Annual Meeting & Exposition; December 7-10, 2019; Orlando, FL. Abstract 324.