Intensified Treatment Approach May Improve Survival in Some Patients With Myeloma
Posted: Friday, July 20, 2018
According to a recent study published in Clinical Lymphoma, Myeloma & Leukemia, consolidation with high-dose therapy and autologous stem cell transplantation (HDT-ASCT) appears to prolong survival compared with a nontransplantation strategy in patients with multiple myeloma who have achieved a complete response. To obtain sustained complete response and minimal residual disease negativity remain the goal of treatment for these patients, the investigators commented.
“To the best of our knowledge, the present study is the first data set showing that, among [complete response] patients, the choice of consolidation regimen continues to favor the use of HD-ASCT independently of [International Staging System] stage and cytogenetic risk,” stated Sara Bringhen, MD, PhD, of the University of Torino, Italy, and colleagues.
Two phase III trials—GIMEMA-RV-MM-PI-209 and RV-MM-EMN-441—were the focus of this retrospective analysis. A total of 166 patients (21% of the 791 patients in both studies) who achieved a complete response to induction therapy were included in the current analysis. Then patients were stratified by the type of consolidation treatment received (HDT-ASCT or R-Alk [lenalidomide, alkylator-based chemotherapy]) and the type of maintenance therapy (rituximab-based or none). A total of 95 patients were in the HDT-ASCT group and 71 patients were in the R-Alk group; 122 received maintenance therapy, and 44 did not.
Those who received HDT-ASCT had a survival advantage over those who received R-Alk, with a better progression-free survival, second progression-free survival, and overall survival. In fact, the survival benefit was confirmed among all subgroups. In addition, maintenance therapy was associated with improved progression-free survival over no maintenance therapy (at 4 years, 54% vs. 19%), but no differences were reported in regard to second progression-free and overall survival.