Comparison of single and double autologous stem cell transplantation in multiple myeloma patients

Abstract

Background Autologous stem cell transplantation (ASCT) is one of the standard treatments of choice for eligible multiple myeloma (MM) patients. Herein, we aimed to analyze MM patients at our center and compare the clinical outcomes of single and double ASCT patients. Materials and methods Patients who were diagnosed as having MM and had undergone single or double ASCT in our clinic between the years 2003 and 2020 were retrospectively examined. Results In this study, the median time of second ASCT is approximately 3.6 years from the first ASCT. Overall survival (OS) duration of the single and double transplanted groups was 4,011 ± 266 vs 3,526 ± 326 days, respectively (p: 0.33). Progression-free survival (PFS) duration of the single and double transplanted groups was 2,344 ± 228 vs 685 ± 120 days, respectively (p: 0.22). Disease assessment after ASCT stable or progressive disease, partial remission, and very good partial or complete remission (CR) in single and double ASCT groups was 62/44/105 and 8/4/5, respectively (p: 0.22). Conclusion The present study points out that the second ASCT treatment option for MM patients may not be effective as suggested, especially in the era of novel MM drugs, since our results come from the past data that novel drugs were not exist. In conclusion, we found no benefit with second ASCT in MM patients in terms of PFS and OS or CR rates, and the novel anti-myeloma drugs might decrease the need for a second transplant.

The Efficacy and Safety of Tandem Transplant Versus Single Stem Cell Transplant for Multiple Myeloma Patients: A Systematic Review and Meta-Analysis

“…Of these, 1385 records w because they did not meet the inclusion criteria, leaving 28 articles for full-te After reviewing the full texts of these 28 articles, 16 were further excluded for the following reasons: ineligible study design (n = 5), ineligible comparator (n = 3), ineligible outcomes (n = 4), and incomplete or duplicated data (n = 4). Ultimately, 12 studies, including nine randomized controlled trials [6,[15][16][17][18][19][20][21][22][23] and three retrospective cohort studies [24,25,30], met the inclusion criteria and were included in the meta-analysis. These 12 studies involved a total of 5057 patients with newly diagnosed MM who underwent either tandem ASCT or single ASCT.…”

“…Given the conflicting evidence and ongoing debates surrounding the use of tandem ASCT in MM, there is a pressing need for a comprehensive and updated systematic review and meta-analysis to synthesize the available data and provide evidence-based recommen-dations for clinical practice. While previous meta-analyses have been conducted on this topic [24,25], they have several limitations, such as the inclusion of a small number of trials, lack of subgroup analyses, and failure to account for the quality of included studies.…”

An Update on Hematopoietic Stem Cell Transplantation in Patients with Multiple Myeloma

“…However, in the era of novel agents; where novel anti-myeloma drugs are used in induction as well as maintenance therapy; the use of novel therapies might decrease the need for a second transplant and tandem transplantation may not improve OS or PFS in either SR MM or HR MM patients compared to a single transplant [115,116]. Additionally, the alternative treatment approach to tandem autologous HSCT which is the total therapy 3 (TT3) that includes induction, tandem autologous HSCT, consolidation, and maintenance, has allowed one of the best outcomes in terms of CR/nCR, OS, and PFS [117].…”

“…Additionally, the alternative treatment approach to tandem autologous HSCT which is the total therapy 3 (TT3) that includes induction, tandem autologous HSCT, consolidation, and maintenance, has allowed one of the best outcomes in terms of CR/nCR, OS, and PFS [117]. Therefore, induction therapy with novel agents followed by single autologous HCT and maintenance therapy should remain as the standard of care for newly diagnosed MM patients who are transplant eligible [115,116].…”

Recent Updates on Multiple Myeloma

“…No dose adjustment is mandatory for this MoAb in case of renal impairment of any degree. The combinations of Elotuzumab in phase III studies were welltolerated by MM patients with renal impairment, including patients with terminal renal failure, and effective [116,117].…”