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Real-world Outcomes of ASCT in Initial Therapy in Patients With Newly Diagnosed Multiple Myeloma
Autologous stem cell transplant (ASCT) is an important option as part of initial therapy for eligible patients with multiple myeloma (MM). Healthier, younger patients in Canada are usually offered ASCT, while some centers offer tandem ASCT to high-risk patients. Julie Cote, MD, and colleagues examined details and outcomes of ASCT in initial therapy in eligible patients in their presentation “Real-world results of autologous stem cell transplantation in newly diagnosed patients with multiple myeloma: A multi-institutional report from the Canadian Myeloma Research Group database” at the 64th American Society of Hematology Annual Meeting and Exposition.
“The national myeloma database, now consisting of over 8,800 patients, aims to evaluate real-world patterns of treatment, outcomes, risk factors, and areas for future research in multiple myeloma,” Dr Cote said.
Cote and colleagues used the database to track and define the real-world outcomes of 3,821 patients treated at 17 major institutions throughout Canada. Patients who received an ASCT as part of their initial MM therapy between January 1, 2007, and December 31, 2021, were included.
"This information will allow physicians to have a better understanding of first-line therapy in this population and its impact on clinical outcomes, potentially leading to improved health care delivery,” Dr Cote said.
Progression-free survival (PFS; calculated from the time of first ASCT until disease progression, death due to any cause, or last follow-up) and overall survival (OS; defined as the time from ASCT to the date of death or last follow-up) were examined.
Median age of study participants was 61 (range 26-77) years. The majority (82%) received bortezomib-based induction, consisting of CyBorD in 72% with rates of ≥partial response (PR) (≥very good partial response [VGPR]) of 92% (60%) with rates of ≥PR (≥VGPR) of 92% (60%); 1.6% received a proteasome inhibitor + lenalidomide; rates of ≥PR (≥VGPR) were 96.5% (63.2%) in this subgroup. Median time to ASCT from the start of induction was 5.6 months.
A second induction regimen that included lenalidomide in 78.5% was administered to 376 patients for suboptimal response and/or progression on first induction. The ≥PR (≥VGPR) rates in these 376 patients was 72.9% (35.4%); median time from start of second induction to ASCT was 4.2 months. Tandem ASCT was performed in 314 patients, with a majority being high-risk patients.
"Tandem transplant was primarily performed in high-risk patients, indeed, 64% of the patients receiving a tandem transplant were high risk defined by FISH [fluorescence in situ hybridization test],” Dr Cote said. “In this study, ‘high-risk’ was defined by the presence by FISH of del17p, t(4;14), or t(14;16).”
The median PFS (mPFS) and median OS (mOS) for all patients was 35.4 months (95% confidence interval [CI] 33.7–37.3) and 125 months (95% CI 120–138), respectively, from the first ASCT. Patients who had received a second induction regimen had significantly lower outcomes (mPFS 27.9 vs 36.2 months [P = .001]; mOS 118 vs 126 months [P = .011]), although the use of maintenance resulted in comparable outcomes regardless of number of induction regimens (mPFS 55.3 vs 51.1 months [P = .11]; mOS 158.6 vs not yet reached [P = .13]).
“This large study covering 15 years in the real-world setting demonstrates that the integration of bortezomib and lenalidomide into the transplant sequence produces a medial overall survival of over 10 years in most autologous stem cell transplant patients,” Dr Cote concluded. “It also highlights the contributions of post-autologous stem cell transplant maintenance, particularly lenalidomide given until progression, when used in multiple subgroups including those with and without high risk, as well as those requiring a second course of induction.”
Further analyses are in progress to assess the relationship of patient characteristics, specific treatment details, and outcomes, Cote said.
Cote J, Leblanc R, Chu M, et al. Real-world results of autologous stem cell transplantation in newly diagnosed patients with multiple myeloma: A multi-institutional report from the Canadian Myeloma Research Group database. Presented at the 64th ASH Annual Meeting and Exposition. December 10-13, 2022. Abstract 117.
