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/m² for 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.

IN PRACTICE:

“The GMMG ReLApsE trial does not support SHDCT/ASCT at relapse after prior frontline HDCT/ASCT regardless of TTP1,” authors of the study wrote.

SOURCE:

The study was led by Marc-Andrea Baertsch, University Hospital Heidelberg in Heidelberg, Germany. It was published online on April 17 in Blood.

LIMITATIONS:

According to the authors, the interpretation of overall survival outcomes was complicated by the substantial use of posttrial sHDCT/ASCT in the control arm. Additionally, the lenalidomide/dexamethasone reinduction before sHDCT/ASCT may not have been optimal compared with more active triplet regimens.

DISCLOSURES:

The study was supported by the Dietmar Hopp Foundation, Celgene, Chugai, and Amgen. Baertsch reported having relationships with Takeda, Novartis, Sanofi, Stemline, Celgene, Amgen, and Janssen.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.