Dr. Giralt on Long-Term Outcomes with HSCT in Multiple Myeloma

Sergio A. Giralt, MD, deputy division head, Division of Hematologic Malignancies, Melvin Berlin Family Chair in Multiple Myeloma, Memorial Sloan Kettering Cancer Center, discusses long-term outcomes with hematopoietic stem cell transplant (HSCT) in multiple myeloma.

High-dose melphalan (HDM) combined with HSCT (HDM-HSCT) has been a long-established standard of care (SOC) for patients in the frontline setting, Giralt begins. The agent has been evaluated in several randomized trials , mainly as a consolidation therapy following induction therapy, Giralt states. HDM-HSCT is considered a fairly safe regimen, with a low non-relapse mortality rate and is effective in both newly diagnosed and relapsed/refractory multiple myeloma, he says.

Previous phase 3 trials indicate that up-front HDM-HSCT is associated with increased progression-free survival (PFS) and high clinical benefit compared with patients who receive delayed transplant, Giralt continues.

For example, the phase 3 IFM 2009 study (NCT01191060) of lenalidomide (Revlimid), bortezomib(Velcade) and dexamethasone (RVd) followed by either HDM-HSCT or subsequent RVd therapy and lenalidomide maintenance demonstrated a 30% reduction in the risk of progression or death in patients receiving transplant. The DETERMINATION trial (NCT01208662) also showed a 21.3-month gain in median PFS with the use of RVd followed by HSCT in young, newly diagnosed patients vs patients who received RVd without transplant. Notably, all trials did not show an increased OS benefit with up-front transplant compared with delayed transplant, Giralt says.

Regardless, patients with standard- or high-risk disease should still consider initial treatment with HDM-HSCT to achieve long-term disease control, Giralt concludes.