High and low melphalan doses were associated similar post-autologous peripheral blood stem cell transplant (ASCT) survival outcomes among patients with multiple myeloma (MM). These findings were published in Leukemia & Lymphoma.
The standard conditioning treatment for ASCT is high-dose (200 mg/m2) melphalan therapy. However, some studies have shown that lower doses can elicit effective responses.
In this study, researchers evaluated post-ASCT outcomes on the basis of melphalan dosing in 459 consecutive patients at the All India Institute of Medical Sciences: 69 patients received 150 mg/m2 or lower and 390 patients received high-dose melphalan pretransplant.
Patients were median age 52 years, 65.8% were men, 35.8% had International Staging System (ISS) III disease, and 58.8% had comorbidities.
High-dose treatment was associated with a higher complete response rate (66.2%) and very good partial response rate (17.2%) but lower partial response rate (10.3%) compared with low-dose treatment (62.3%, 10.1%, 13.0%, respectively).
More low-dose melphalan recipients had post-ASCT stable disease (7.2%) or died (7.2%) compared with high-dose recipients (2.3%, 4.1%, respectively).
Overall survival (median, 100.0 months in the low-dose group vs 102.0 months in the high-dose group; P =.817) and progression-free survival rates (median, 60.0 vs 53.0, respectively; P =.746) did not differ. Survival outcomes were dependent on level of response (both P <.001) but not on melphalan dose (P =.841).
The 12-month relapse rates were 11.8% for low-dose and 13.7% for high-dose treatment (P =.677).
The limitations of this study included the cohort imbalances and missing data.
These data confirmed that lower dose melphalan had similar post-ASCT survival outcomes and relapse rates as standard dosing and can be considered an effective option for those who are ineligible for high-dose treatment.
Kumar L, Sahoo RK, Kumar S, et al. Autologous stem cell transplant for multiple myeloma: Impact of melphalan dose on the transplant outcome. Leuk Lymphoma. Published online November 23 2022. doi:10.1080/10428194.2022.2148214