A recent study examined treatment outcomes for patients with newly diagnosed multiple myeloma and chromosome 13q deletion (del13q). Outcomes were compared for first-line treatment with tandem autologous stem cell transplantation (autoSCT) or autoSCT followed by allogeneic stem cell transplantation (alloSCT). Study results were published in Leukemia.
“In summary, in the present trial, upfront alloSCT significantly extended progression-free survival (PFS) [compared with] tandem autoSCT,” the study authors wrote in their report.
In this phase 3 trial (ClinicalTrials.gov Identifier: NCT00546988), if patients tested positive for the presence of del13q, they were included in this analysis. One arm of the study was treated with tandem autoSCT (73 patients). Patients in the other study arm received autoSCT followed by alloSCT, in a combination termed “auto/alloSCT” (126 patients). Patients undergoing alloSCT received reduced-intensity conditioning, and transplants came from either human leukocyte antigen-matched sibling donors or matched unrelated donors.
Median study follow-up occurred at 91 months (range, 2-143). Median progression-free survival (PFS) with auto/alloSCT was 34.5 months, compared with 21.8 months for tandem autoSCT (P =.003). Auto/alloSCT was associated with a 2-year PFS rate of 59.0% (95% CI, 49.2%-67.6%), compared with a rate of 46.8% (95% CI, 34.6%-58.1%; P =.005) for tandem autoSCT.
Patients receiving auto/alloSCT showed a median overall survival (OS) of 70.2 months, compared with a median OS of 71.8 months with tandem autoSCT, though this was not a significant difference (P =.856).
In a subset of 25 patients who additionally held a chromosome 17p deletion (del17p), the median PFS with auto/alloSCT was 37.5 months, compared with 6.1 months for tandem autoSCT (P =.0002). In patients with del17p, median OS with auto/alloSCT was 61.5 months, while it was 23.4 months with tandem autoSCT (P =.032).
The researchers concluded that upfront auto/alloSCT may confer a significant PFS benefit over tandem autoSCT in patients with multiple myeloma and del13q, and with promising results for patients with del17p. They also noted that the ideal positioning of auto/alloSCT among available treatments is not yet clear.
- Knop S, Engelhardt M, Liebisch, et al. Allogeneic transplantation in multiple myeloma: long-term follow-up and cytogenetic subgroup analysis [published online August 28, 2019]. Leukemia. doi:10.1038/s41375-019-0537-2