1.
High Dose Chemotherapy with Early Autologous Stem Cell Transplantation Compared to Standard Dose Chemotherapy or Delayed Transplantation in Patients with Newly Diagnosed Multiple Myeloma: A Systematic Review and Meta-analysis
Jain, T., Sonbol, M. B., Firwana, B., Kolla, K. R., Almader-Douglas, D., Palmer, J., Fonseca, R.
Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation. 2018
Abstract
Autologous stem cell transplantation (SCT) is the standard of care for all transplant eligible patients diagnosed with multiple myeloma (MM). Various studies have compared clinical outcomes with frontline SCT ("Early SCT") versus standard dose therapy (SDT) alone, with or without salvage SCT ("SDT/ late SCT"). In this meta-analysis, we compare overall survival (OS) and progression free survival (PFS) outcomes with these two treatment approaches. Twelve studies were identified, including 3,633 patients, of which 1,811 received early SCT while 1,822 received SDT/ late SCT. OS was not significantly different (HR 0.86, 95% CI 0.70 - 1.04) while PFS was better with early SCT (HR 0.67, 95% CI 0.54 - 0.82) in the analysis of all 12 studies. In a subgroup analysis of three studies using novel agents for induction, OS was similar but PFS was favorable with early SCT (HR 0.50, 95% CI 0.36 - 0.70). This analysis shows that over the years, early SCT was associated with a prolonged PFS but did not consequentially translate into prolongation of OS, in patients with newly diagnosed MM. The benefit of early SCT in terms of OS is less clear in the era of novel agents as these studies have limited follow up.
2.
Evaluation of Revised International Staging System (R-ISS) for transplant-eligible multiple myeloma patients
Gonzalez-Calle, V., Slack, A., Keane, N., Luft, S., Pearce, K. E., Ketterling, R. P., Jain, T., Chirackal, S., Reeder, C., Mikhael, J., et al
Annals of hematology. 2018
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Editor's Choice
Abstract
The International Myeloma Working Group has proposed the Revised International Staging System (R-ISS) for risk stratification of multiple myeloma (MM) patients. There are a limited number of studies that have validated this risk model in the autologous stem cell transplant (ASCT) setting. In this retrospective study, we evaluated the applicability and value for predicting survival of the R-ISS model in 134 MM patients treated with new agents and ASCT at the Mayo Clinic in Arizona and the University Hospital of Salamanca in Spain. The patients were reclassified at diagnosis according to the R-ISS: 44 patients (33%) had stage I, 75 (56%) had stage II, and 15 (11%) had stage III. After a median follow-up of 60 months, R-ISS assessed at diagnosis was an independent predictor for overall survival (OS) after ASCT, with median OS not reached, 111 and 37 months for R-ISS I, II and III, respectively (P < 0.001). We also found that patients belonging to R-ISS II and having high-risk chromosomal abnormalities (CA) had a significant shorter median OS than those with R-ISS II without CA: 70 vs. 111 months, respectively. Therefore, this study lends further support for the R-ISS as a reliable prognostic tool for estimating survival in transplant myeloma patients and suggests the importance of high-risk CA in the R-ISS II group.