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Salvage Transplant in Myeloma?
Does salvage transplant in myeloma help MM patients live longer? According to the research linked below, no, salvage ASCT shows no survival benefit.
To be clear, a salvage ASCT is not an FDA standard-of-care therapy ASCT that follows induction therapy for all NDMM patients. A salvage ASCT is not a tandem ASCT. A salvage ASCT is that ASCT that follows both an immediate ASCT, remission and then relapse.
I found the top finding below to be contradictory to all other findings regarding the benefit of salvage transplantation. The only difference I can determine is with the history of salvage ASCT findings, and the findings below are that “continuous dexamethasone/lenalidomide is a superior therapy for relapsed MM patients when compared to salvage ASCT.
I am a long-term MM survivor. Email me at David.PeopleBeatingCancer@gmail.com with questions about your MM.
Good luck,
David Emerson
- MM Survivor
- MM Cancer Coach
- Director PeopleBeatingCancer
Myeloma: Does Salvage Transplant Show Benefit?
TOPLINE:
After a median follow-up of 99 months, salvage high-dose chemotherapy and autologous stem cell transplantation (sHDCT/ASCT) showed no survival benefit compared with continuous lenalidomide/dexamethasone in relapsed multiple myeloma. The absence of benefit was consistent across all subgroups, including patients with time to progression after frontline transplant beyond 48 months.
METHODOLOGY:
- Researchers randomized 277 patients with relapsed and/or refractory multiple myeloma equally to receive either lenalidomide/dexamethasone reinduction followed by sHDCT/ASCT and lenalidomide maintenance or continuous lenalidomide/dexamethasone.
- Participants received lenalidomide 25 mg on days 1-21 and dexamethasone 40 mg weekly in 4-week cycles, with the transplant arm receiving melphalan 200 mg/m2for sHDCT followed by lenalidomide maintenance at 10 mg daily.
- Analysis included 94% of patients who had received frontline HDCT/ASCT, with 38% having received frontline tandem HDCT/ASCT, and 11% having previous lenalidomide exposure.
TAKEAWAY:
- Median progression-free survival was 20.5 months (95% CI, 15.9-27.2) in the transplant arm vs 19.3 months (95% CI, 14.9-25.4) in the control arm (hazard ratio [HR], 0.98; 95% CI, 0.76-1.27; P = .9).
- Overall survival showed no significant difference between arms, with median 67.1 months (95% CI, 59.2-85.4) vs 62.7 months (95% CI, 49.6-86.0) for the transplant arm vs the control arm (HR, 0.89; 95% CI, 0.66-1.20; P = .44).
- Time to progression after frontline transplant did not predict benefit from salvage transplant, with no significant differences in survival even among patients with progression time beyond 48 months.
- A 29% dropout rate was observed in the transplant arm before sHDCT/ASCT, primarily due to disease progression, adverse events, and withdrawal of consent.
Outcomes of Salvage Autologous Stem Cell Transplantation in Relapsed Multiple Myeloma: A Meta-Analysis
Background: Salvage autologous stem cell transplant (SAT)is an alternative treatment option for relapsed multiple myeloma patients that offers additional progression-free survival (PFS2) and overall survival (OS2) advantage over salvage chemotherapy. We conducted a meta-analysis to evaluate the outcomes of salvage transplant in patients with relapsed multiple myeloma after initial transplant…
Conclusion: SAT approach had favorable outcomes of achieving durable PFS and OS in relapsed myeloma patients. A Higher TRM was observed with salvage transplant than in upfront transplant. Prospective randomized trials are needed to define benefits of SAT in comparison with “best non-ASCT” therapy in patients with MM who relapse after primary therapy.”