“Patients with multiple myeloma (MM) who are eligible for autologous stem cell transplantation (ASCT) typically receive a finite period of initial therapy before ASCT. It is not clear if patients with suboptimal (less than a partial) response to initial therapy benefit from additional alternative therapy with intent to maximize pretransplant response.
We identified 539 patients with MM who had an ASCT after having achieved less than a partial response (PR) to first-line induction chemotherapy between 1995 and 2010.
These patients were then divided into 2 groups:
- those who received additional salvage chemotherapy before ASCT (n = 324) and
- those who had no additional salvage chemotherapy immediately before ASCT (n = 215).
Additional pretransplant chemotherapy resulted in deepening responses in 68% (complete response in 8% and PR in 60%).
On multivariate analysis there was no impact of pretransplant salvage chemotherapy on
- treatment-related mortality,
- risk for relapse,
- progression-free survival, or
- overall survival.
In conclusion, for patients achieving less than a PR to initial induction therapy, including with novel agent combinations, additional pre-ASCT salvage chemotherapy improved the depth of response and pre-ASCT disease status but was not associated with survival benefit.”
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