A study published in Leukemia found that upfront autologous hematopoietic cell transplantation (AHCT) and melphalan prolonged progression-free survival (PFS; primary endpoint) in young, newly diagnosed patients with multiple myeloma (MM), compared with salvage AHCT at the time of first relapse after chemotherapy plus lenalidomide. These findings suggest that AHCT with melphalan is a reasonable early treatment for this patient population.
Francesca Gay, MD, of the Myeloma Unit in the Division of Hematology at the University of Torino in Italy, and co-authors conducted a pooled analysis of two phase III trials (RV-MM-209 and EMN-441), which included 529 treatment-naïve patients who received either two courses of melphalan 200 mg/m2 and upfront AHCT (n=268) or chemotherapy plus lenalidomide followed by salvage AHCT (systemic therapy group; n=261).
After a median follow-up of 46 months, upfront AHCT was associated with a 47 percent reduction in the risk of first progression or death (median PFS = 42 vs. 24 months; hazard ratio [HR] = 0.53; p<0.001), as well as a 47 percent reduction in the risk of second progression or death (4-year PFS: 71% vs 54%; HR=0.53; p<0.001).
In addition, patients who received upfront AHCT and melphalan had a 49 percent reduced risk of death (HR=0.51; p<0.001), compared with patients who received chemotherapy plus lenalidomide and salvage AHCT. Rates of four-year overall survival were also higher in the upfront AHCT group: 84 percent versus 70 percent (HR=0.51; p<0.001).
Only 53 percent of patients who relapsed after systemic therapy received AHCT at first relapse, the researchers reported. Compared with salvage AHCT, upfront AHCT significantly reduced the risk of death by 49 percent (HR=0.51; p=0.007).
The authors noted that the heterogeneity between the trials may limit this study’s findings.
Source: Gay F, Oliva S, Petrucci MT, et al. Autologous transplant vs oral chemotherapy and lenalidomide in newly diagnosed young myeloma patients: a pooled analysis. Leukemia. 2017 January 24. [Epub ahead of print]