Stem cell transplantation and lenalidomide improves survival of patients with multiple myeloma

This article investigated the safety and effectiveness of high-dose therapy with autologous stem cell transplantation (HDT-ASCT) and maintenance treatment (treatment meant to keep cancer from coming back) with lenalidomide (Revlimid) for patients with multiple myeloma. The authors concluded that this therapy is safe and can improve the overall survival of these patients.

Targeted therapy including lenalidomide (lenalidomide-alkylator regimen; R-Alk) is the current standard treatment for patients with multiple myeloma (MM). However, the average overall survival (OS) is 2-3 years in these patients. 

An alternative treatment method is high-dose therapy and autologous stem cell transplantation (HDT-ASCT) and maintenance treatment with lenalidomide. This treatment uses high dose melphalan (Alkeran; a chemotherapy drug which destroys cancer cells) and an autologous stem cell transplant (healthy stem cells are removed from the patient, stored, and later given back to that same patient). This is then followed by maintenance therapy with lenalidomide. The effects on overall survival and safety of HDT-ASCT and maintenance treatment with lenalidomide are still under investigation.

This study involved 166 patients with MM from 2 trials who had a complete response (CR; no signs of cancer) after first-line treatment. They were randomly assigned to two groups, based on consolidation treatment (treatment meant to kill any cancer cells that might be left in the body). Group 1 received treatment with HDT-ASCT (95 patients). Group 2 received treatment with R-Alk (71 patients). After achieving a CR, these patients received lenalidomide maintenance (73%) or no maintenance treatment (27%). The outcomes measured were progression-free survival (PFS; the time it took for cancer to start growing again), and overall survival (OS).

After an average follow-up of 48 months, patients in group 1 were 45% less likely to have cancer progression compared with group 2. Patients in group 1 were also 58% less likely to die compared with group 2.

Patients who received maintenance with lenalidomide were 57% less likely to have cancer progression at 4 year follow up compared to the no maintenance group. There was no difference in overall 4 year survival between the two groups (79% with lenalidomide maintenance vs. 72% with no maintenance).

The authors concluded that in patients with MM who achieved a CR after first-line therapy, consolidation with HDT-ASCT followed with a lenalidomide-based maintenance induced a safe and effective response. 

The patients included in this study came from 2 trials with different treatment protocols. Also, information about the number of remaining cancer cells was missing. This might have changed the outcomes.