The following article features coverage from the American Society of Hematology 2019 Annual Meeting. Click here to read more of Oncology Nurse Advisor‘s conference coverage.

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.


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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).

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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.