When should stem-cell transplants be given during multiple myeloma treatment?

This study was carried out to determine whether early stem cell transplant (SCT) or a delayed SCT improved the survival of patients with multiple myeloma (MM). The study found that there was no significant difference in survival in patients with newly diagnosed MM who received early or late SCT. 

SCT is an important part of the treatment for patients with MM. In a SCT, the patient gets high-dose chemotherapy and/or radiotherapy to kill the cancer cells in the bone marrow. Then, the patient receives new, healthy blood-forming stem cells.

For an autologous (auto) SCT, the patient’s own stem cells are removed from his or her bone marrow or peripheral blood before the transplant. There have been few studies that have assessed the timing of autoSCT in combination with new targeted therapies.  

There were 514 patients with newly diagnosed MM in this study. 227 patients underwent SCT within 12-months of diagnosis with MM (early group). 287 patients underwent delayed SCT (after 12 months from diagnosis). The average time it took for patients in the early group to undergo SCT was 7.7 months. The average time before patients underwent SCT in the delayed group was 22.3 months. 

The average overall survival in the early group was similar to the delayed group (84 months vs 90 months). The average time patients in the early group survived without cancer progression was 37 months compared to 40 months in the delayed group. In patients who relapsed a second time. the average survival without cancer worsening was 52 months in the early group vs. 54 months in the delayed group.

The authors concluded that in patients with newly diagnosed MM, the timing of SCT did not have significant impact on survival.

This trial was carried out in a single institute. Therefore, its findings may not translate well to a global population. Also this study was based on medical records. Some information might have been missing.