Reviewer: Neha Vapiwala, MD
Abramson Cancer Center of the University of Pennsylvania
Last Modified: March 23, 2007
Presenter: Björkstrand, Bo
Presenter's Affiliation: Huddinge University Hospital, Sweden
Type of Session: Scientific
Multiple myeloma (MM) is one of the most common indications for high-dose chemotherapy and transplantation in Sweden. Autologous stem cell transplantation (AuSCT) is currently considered the standard of care in young patients with multiple myeloma (MM). Attal et al. (NEJM 1996;335(2):91-7) were the only group to report an overall survival (OS) benefit in a prospective, randomized study comparing double to single transplants in a 399 younger MM patients, demonstrating a doubling of the OS from 42% vs. 21%. Several other randomized studies are in favor of double ("tandem") autologous transplantation, but the long-term benefit remains unclear. This study was initiated in order to assess the long-term effect of double vs. single transplantation in this population.
Materials and Methods
As compared with single autologous stem-cell transplantation, up front double transplantation did not seem to improve the final outcome among patients with multiple myeloma in the Nordic area.
In a country like Sweden where socialized medicine prevails, performing routine tandem transplants for the initial treatment of all favorable myeloma patients without clear evidence of its long-term efficacy is not an affordable luxury. In this very important phase II registration study, it does not appear that double transplant offers any statistically significant overall survival advantage over single transplant. Although the five-year event-free survival was better with the double transplant arm, it is not considered to be a compelling enough endpoint to justify this approach universally, and thus single AuSCT remains the standard of care for this geographical region. In the future, a phase III trial in this population may be warranted, as randomization of patients would provide more confident data, and it is not clear in this phase II study how patients were selected to be in either the single or double transplant groups.