Second High-Dose Therapy and Autologous Stem Cell Transplant Demonstrates Efficacy and Tolerability for Patients With MM in First Relapse

Consolidative high dose therapy/ autologous stem cell transplantation (HDT/ASCT) as second-line for patients in first relapse of multiple myeloma (MM) demonstrates improved overall survival (OS) and time between treatments, according to results from a retrospective cohort study published in Clinical Lymphoma, Myeloma & Leukemia.

For patients with MM, HDT/ASCT has been the standard first-line therapy and has shown potential for second use after reasonable remission duration. However, research remains limited on outcomes of consolidative HDT/ASCT as second line treatment for patients with MM in first relapse who are transplant eligible. Researchers sought to determine the real-world impact of HDT/ASCT, as first- and second-line therapy for MM, among patients in first relapse. The primary outcomes were time to next treatment or death (TTNT-D), and overall survival.

Overall, 237 patients with MM in first relapse who previously received HDT/ASCT and were in remission for at least 18 months without maintenance therapy or over 24 months with maintenance therapy were included.  The overall median TTNT-D was 29 months (95% confidence interval [CI], 25 to 33). Among included patients, 111 received second HDT/ASCT, of which 97% achieved a partial response (PR), while only 60% of patients who did not receive second HDT/ASCT (n=126) achieved a PR. The OS for all patients was 60 months (95% CI; 49 to 71).

Results from a landmark analysis of patients who responded (n = 168) revealed a TTNT-D of 22 months (95% CI, 30 to 36 months). Among patients with second HDT/ASCT, the TTNT-D was lower than those who only received first HDT/ASCT (35 months; 95% CI; 31 to 39 vs 44 months; 95% CI; 40 to 48, respectively).  The OS for patients with second HDT/ASCT was higher than patients only with first HDT/ASCT (80 months; 95% CI; 58 to 102 vs 63 months; 95% CI; 38 to 88, hazard ratio [HR]= 1.76; P= .02).

“This treatment approach could provide a long treatment-free interval with additional financial and quality of life benefits,” the researchers concluded, “Further head-to-head comparisons with highly effective novel treatment options including bispecific antibodies and CAR-T cells are warranted.”

Source:

Klomberg KM, Gelderloos M, Kooistra HAM, et al. Consolidation with second high dose therapy and autologous stem cell transplantation is associated with improved overall survival in patients with multiple myeloma in first relapse. Clinical Lymphoma Myeloma and Leukemia. Published online December 23, 2024. doi: 10.1016/j.clml.2024.12.010