In a nutshell
This study evaluated the outcomes of autologous stem cell transplantation (ASCT) for patients with recurrent multiple myeloma (MM). This study found that long-term outcomes for these patients were promising, especially for patients who had the transplant right away after a first relapse.
Multiple myeloma (MM) is a type of cancer of the bone marrow that can lead to abnormal immune cells. Autologous stem cell transplantation (ASCT) remains a standard first-line treatment for patients with MM. High-dose chemotherapy is given first to get rid of any remaining cancer cells. Then, healthy stem cells are collected from the patient’s bloodstream. After treatment, these healthy cells are given back to the patient to help create new blood cells.
Salvage ASCT is one treatment option for patients with MM that returns after initial treatment (relapse). After the transplant, maintenance therapy may be recommended. This is low-intensity therapy given over an extended period to help delay relapse. The long-term outcomes of ASCT for patients with relapsed MM remain under investigation.
Methods & findings
This study included 168 patients with relapsed MM. 21% of patients had received a prior transplant. In this study, 69% of patients underwent ASCT after a first relapse. After the transplant, 35% of patients received maintenance therapy for an average of 7 months. Patients were followed up for an average of 61 months.
After high-dose chemotherapy, 8% of all patients had no signs of cancer. 72% of patients had tumor shrinkage. 10% of patients had neither tumor growth nor shrinkage (stable disease). Overall, 94% of patients responded to ASCT. 82% of patients had very good tumor shrinkage or better. 24% of the patients had no signs of cancer, and 58% had tumor shrinkage after ASCT.
Overall, patients survived an average of 55 months after the transplant. On average, patients survived an average of 19 months without tumor growth or spread. Having tumor shrinkage or better was significantly associated with a longer survival without tumor growth or spread than patients who did not (30 months vs. 19 months).
Undergoing ASCT after the first relapse was significantly associated with better outcomes compared to ASCT after a second or later relapse. ASCT after the first relapse was significantly associated with longer overall survival compared to second or later relapse (75 months vs. 39 months). ASCT after the first relapse was significantly associated with a 37% lower risk of tumor growth or spread compared to second or later relapse. Time spent without tumor growth or spread was also significantly longer (22 months vs. 14 months).
Undergoing ASCT right away after the first relapse was also significantly associated with better outcomes than delaying the transplant. Patients who had ASCT right away survived for significantly longer without tumor growth or spread than patients who waited (48 months vs. 20 months). Also, significantly more patients who had ASCT right away were still alive 10 years later than patients who delayed (60% vs. 36%).
The bottom line
This study found that patients with recurrent MM had promising long-term outcomes after ASCT. The authors suggest that receiving ASCT upfront rather than later on during treatment may lead to better outcomes.
The fine print
This study looked back in time to analyze data. Also, the patients in this study had a variety of treatments prior to undergoing ASCT. Lastly, only 35% of patients received maintenance therapy.
Talk to your care team about the potential benefits of ASCT.
Published By :
Bone Marrow Transplantation
Jun 23, 2021
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