Autologous transplant vs oral chemotherapy and lenalidomide in newly diagnosed young myeloma patients: a pooled analysis

F. Gay, S Oliva, Maria T. Petrucci, V Montefusco, C. Conticello, P Musto, L. Catalano, A Evangelista, S. Spada, P. Campbell, R. Ria, M. Salvini, M. Offidani, A M Carella, P Omedé, A. M. Liberati, R Troia, A. M. Cafro, A Malfitano, A P FalconeT. Caravita, F. Patriarca, A. Nagler, Craig A. Spencer, Rom Hajek, A. A. Palumbo, M. Boccadoro

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In newly diagnosed myeloma patients, upfront autologous transplant (ASCT) prolongs progression-free survival 1 (PFS1) compared with chemotherapy plus lenalidomide (CC+R). Salvage ASCT at first relapse may still effectively rescue patients who did not receive upfront ASCT. To evaluate the long-term benefit of upfront ASCT vs CC+R and the impact of salvage ASCT in patients who received upfront CC+R, we conducted a pooled analysis of 2 phase III trials (RV-MM-209 and EMN-441). Primary endpoints were PFS1, progression-free survival 2 (PFS2), overall survival (OS). A total of 268 patients were randomized to 2 courses of melphalan 200 mg/m(2) and ASCT (MEL200-ASCT) and 261 to CC+R. Median follow-up was 46 months. MEL200-ASCT significantly improved PFS1 (median: 42 vs 24 months, HR 0.53; P<0.001), PFS2 (4 years: 71 vs 54%, HR 0.53, P<0.001) and OS (4 years: 84 vs 70%, HR 0.51, P<0.001) compared with CC+R. The advantage was noticed in good and bad prognosis patients. Only 53% of patients relapsing from CC+R received ASCT at first relapse. Upfront ASCT significantly reduced the risk of death (HR 0.51; P=0.007) in comparison with salvage ASCT. In conclusion, these data confirm the role of upfront ASCT as the standard approach for all young myeloma patients.Leukemia advance online publication, 24 January 2017; doi:10.1038/leu.2016.381.

Original languageEnglish
Publication statusE-pub ahead of print - Jan 24 2017


  • Journal Article


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