Upfront autologous stem cell transplantation for newly diagnosed multiple myeloma

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Published: 6 Jun 2016
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Prof Michele Cavo - Seràgnoli Institute of Hematology, Bologna, Italy

Dr Cavo meets with ecancertv at ASCO 2016 to discuss the role of autologous stem cell transplantation (ACST) for multiple myeloma (MM).

With the changing landscape of novel agents, the role of upfront transplantation has been questioned, and was put to the test in a randomized phase III trial comparing 4 cycles of bortezomib-melphalan-prednisone (VMP) against high-dose melphalan (HDM) and single or double ASCT as intensification therapy following induction with bortezomib-cyclophosphamide-dexamethasone and subsequent collection of peripheral blood stem cells.

Progression free survival and partial response rates favour the inclusion of ACST as the preferred treatment for younger, newly diagnosed MM patients, with overall survival data yet to mature.

 

ASCO 2016

Upfront autologous stem cell transplantation for newly diagnosed multiple myeloma

Prof Michele Cavo - Seràgnoli Institute of Hematology, Bologna, Italy


I presented the results of the first interim analysis of a large phase III trial which was conducted by the European Myeloma Network and was aimed at comparing up front auto-transplant versus chemotherapy alone, including bortezomib, for newly diagnosed myeloma patients.


When it comes to the results, is stem cell transplant still the way forward?


At the time the analysis was performed the median follow-up was 26 months; median PFS was not yet reached for patients who were randomised to receive either single or double autologous stem cell transplantation while it was 44 months for patients who were randomised to the standard dose intensification therapy with bortezomib melphalan and prednisone. The difference between the two arms was statistically significant. The progression free survival benefit with autologous stem cell transplantation compared to standard dose VMP was retained across several subgroups of patients at low and high risk, including patients with a low risk and a high risk cytogenetic profile. For both these subgroups of patients randomisation to up front auto-transplant was associated with a 30% relative reduction in the risk of progression or death. In a multivariate Cox regression analysis randomisation to up front auto-transplant was an independent variable favourably affecting progression free survival.


So important results there. Are there any plans to take these results forwards?


Yes, this is a first interim analysis, obviously the follow up is still not mature. However, the results so far obtained do support the conclusion that autologous stem cell transplantation still continues to be the reference treatment for younger and fit patients with newly diagnosed myeloma even in the novel agent era.