What is the best treatment approach for patients newly diagnosed with multiple myeloma?

This study investigated which was the best treatment approach before and after stem cell transplantation (SCT) for patients newly diagnosed with multiple myeloma (MM). The results showed that patients’ survival was better with CRD (cyclophosphamide, lenalidomide, and dexamethasone) chemotherapy than with CTD (cyclophosphamide, thalidomide, and dexamethasone) before SCT and lenalidomide (Revlimid) maintenance after.

In the past few years, many new treatments have emerged which have significantly improved outcomes for patients with MM. While it is standard to give patients high-dose chemotherapy with SCT, patients should also be treated with chemotherapy combinations before SCT. It may also be advantageous to give targeted therapies, such as lenalidomide, after SCT. It is unclear which are the best treatments to give patients before SCT and after.

2042 patients with newly diagnosed MM were divided into two groups. 1021 patients received CRD chemotherapy before SCT. 1021 patients received CTD before SCT. After SCT, 451 patients from both groups received lenalidomide maintenance and 377 patients did not receive additional treatment. Maintenance therapy aims to keep cancer from returning after it has disappeared following initial therapy. Patients’ results were monitored for 36.3 months.

CRD chemotherapy increased patients’ chances of survival by 23% compared to CTD. After 3 years, 82.9% of the CRD group and 77% of the CTD group survived.

CRD increased patients’ chances of surviving without cancer becoming worse by 15% compared to CTD. On average, patients in the CRD group survived 36 months before cancer worsened while patients in the CTD groups survived 33 months before cancer worsened. Similar results were seen for patients regardless of age, gender, MM stage, and genetic mutations.

The chance of patients having no signs of cancer (remission) was 37% higher with CRD treatment than CTD. After SCT, patients who received CRD still had a 25% higher chance of remission than those who received CTD.

The number of patients who developed serious side effects was similar in both the CRD group (59%) and the CTD group (57.7%). The most common serious side effect was infections in both the CRD group (45.2%) and CTD group (46.4%).

After SCT, lenalidomide maintenance improved patients’ survival by 53% compared to no treatment. Patients who received lenalidomide maintenance survived 50 months on average compared to 28 months for patients who did not receive further treatment.

The authors concluded that CRD before SCT and lenalidomide maintenance after SCT gave patients with MM the best treatment results.