Tandem autologous hematopoietic stem cell transplantation (ASCT) may be effective to improve outcomes for patients younger than 40 years old with multiple myeloma, according to research published in the South Asian Journal of Cancer.
MM incidence increases with age, but it can occur in younger patients. Because MM rarely occurs in patients younger than age 40 years, treatment guidelines aren’t well defined for this patient population.
Although outcomes for patients with MM have improved, relapse remains a significant concern. Progression-free survival is about 4 years with novel therapies.
A treatment regimen with high-dose melphalan and ASCT has led to higher remission rates and longer progression-free survival.
This study retrospectively analyzed 5 patients with MM aged between 34 and 40 years who underwent tandem ASCT. A total of 4 patients had planned to undergo tandem ASCT, and 1 patient underwent transplant as a rescue measure. There were 4 male patients and 1 female.
All patients received melphalan as myeloablative conditioning. A total of 4 patients received 200 mg/m2 of melphalan and 1 patient received 140 mg/m2 of melphalan as conditioning for the first and second transplant. At the time of the tandem transplant, 2 patients were in complete remission, 2 were in very good partial remission, and 1 progressed to active disease.
All patients developed mucositis. The authors noted that the patients experienced more adverse events during tandem ASCT, primarily infections. There was no treatment-related mortality at day 30 or at day 100. A total of 3 patients remained in complete remission at a follow-up of 5 years.
From this small sample, the authors concluded that tandem ASCT is feasible and effective in young patients with MM. In this study, responses continued to improve over time.
Naithani R, Dayal N, Rai R. Tandem autologous hematopoietic stem cell transplantation in very young patients with multiple myeloma. South Asian J Cancer. 2020;9(4):233-235. doi:10.1055/s-0041-1727068