Novel therapies developed in the past several decades may have improved long-term survival for patients with multiple myeloma (MM) undergoing autologous stem cell transplantation (ASCT), with more patients in the past several years having what approaches a normal life expectancy, according to research published in Blood Advances. Outcomes differ, however, depending on patient age, disease risk group, and cytogenetic characteristics.
Previously published data suggest that patients with MM had the best survival outcomes in the period between 2002 and 2004, with a 5-year relative survival of 34.7%. However, inevitable disease relapses have been found to occur at increasingly short intervals in this patient population.
ASCT is a further mainstay of MM management, and there are limited data regarding outcomes among patients who undergo the total therapy approach, which involves induction therapy, ASCT, maintenance, and novel therapies as they become available for use. For this study, researchers evaluated outcomes among patients with MM who underwent total therapy and for whom long-term data were available.
Overall, 4329 patients were included in the analysis, with a median age of 58.9 years (range, 17.4-84.9) and 72.1% of patients being younger than 65 years; 2646 patients (61.1%) were male, 3723 (86%) were Caucasian, and 1861 (43%) were enrolled in a total therapy clinical trial. Patients were also categorized by the year in which they underwent ASCT: 1997 or earlier (661 patients), 1998 to 2003 (1002 patients), 2004 to 2008 (1294 patients), 2009 to 2013 (837 patients), and 2014 or later (535 patients).
The overall median follow-up was 10.5 years (range, 0.01-26.4), with patients who received ASCT in 1997 or earlier having the longest median follow-up (21.5 years) and those who received ASCT in 2014 or later having the shortest (2.5 years).
Overall survival improved over the evaluated period, with patients who received ASCT in 2014 or later having a hazard ratio for mortality of 0.35 compared with patients in the 1997 or earlier group (early mortality, 32.3% vs 36.4%). Other independent predictors of early mortality across the patient sample included age of 65 years or greater (37.2% vs 27.6% in patients younger than 65 years), high Gene Expressing Profile 70 risk status (61.4% vs 17.5% for patients with low risk), and presence of a chromosomal abnormality (41.7% vs 22.8% for patients with no abnormalities).
Being enrolled in a total therapy clinical trial was also associated with better early mortality (20.9% vs 37.9% for patients not on a total therapy protocol).
“Going forward, it is clear that continued efforts to control and eradicate residual disease will be important strategies to increase the likelihood of achieving MM cure,” the researchers wrote.
1. Nishimura KK, Barlogie B, van Rhee F, et al. Long-term outcomes after autologous stem cell transplantation for multiple myeloma. Blood Adv. 2020;4:422-431. doi:10.1182/bloodadvances.2019000524