[goldmine848]

New study finds early transplantation better than late

by goldmine848 on Mon Jun 23, 2014 7:54 pm

Interesting article on early ASCT. Hardly conclusive but interesting nonetheless:

Survival in newly diagnosed multiple myeloma improved significantly in patients who underwent early autologous stem cell transplantation (ASCT), according to pooled data from two randomized trials.

The 4-year overall survival was 85% in patients who underwent stem cell transplantation as consolidation therapy versus 76% for those who had transplants after first relapse, reported Federica Cavallo, MD, PhD, of the University of Torino in Italy, and colleagues.

Median time to first progression (PFS1) was almost twice as long in patients who had early stem cell transplantation, and the time to second relapse also was significantly delayed by early transplantation, they said at the European Hematology Association meeting.

http://www.medpagetoday.com/HematologyOncology/Myeloma/46442

[Beacon Staff]

Re: New study finds early transplantation better than late

by Beacon Staff on Tue Jun 24, 2014 1:46 am

Here's the abstract that is discussed in the article above:

Early Autologous Stem Cell Transplantation Improves Survival In Newly Diagnosed Multiple Myeloma Patients

Federica Cavallo* 1, Andrew Spencer2, Francesca Gay1, Roman Hajek3, Maria Teresa Petrucci4, Dina Ben Yehuda5, Angelo Michele Carella4, Letizia Maria Vallone4, Stefania Oliva1, Daniela Petrò4, Claudia Crippa4, Agostina Siniscalchi4, Milena Gilestro1, Luděk Pour6, Laura Maracci4, Norbert Pescosta4, Marina Liberati4, Valeria Magarotto1, Vlastimil Ščudla7, Giulia Benevolo4, Stefano Pulini4, Tommaso Caravita4, Izhar Hardan8, Mario Boccadoro1, Antonio Palumbo1

1Myeloma Unit, Division of Hematology, University of Torino, Torino, Italy, 2Department of Clinical Haematology, Alfred Health, Melbourne, Australia, 3University Hospital Brno and Faculty of Medicine OU, Ostrava, Czech Republic, 4Italian Multiple Myeloma Network, GIMEMA, Italy, 5Hematology Division, Hadassah Medical Center, Jerusalem, Israel, 6BRNO University Hospital Brno and Faculty of Medicine MU, Brno, 7Department of Internal Medicine, University of Hospital Olomouk, Olomouk, Czech Republic, 8Meir Medical Center, Kfar-Saba, Israel

Background: Autologous stem cell transplantation (ASCT) improved outcome compared to conventional chemotherapy in newly diagnosed multiple myeloma (NDMM) patients. The role and timing of ASCT in the era of novel agents is a crucial question. PFS1 defines the time from start of therapy until the occurrence of 1st relapse. PFS2 defines the time from start of therapy until the occurrence of 2nd relapse, incorporating the duration of both 1st and 2nd remission.

Aims: To compare early ASCT versus ASCT at relapse in terms of PFS1, PFS2 and OS.

Methods: We analyzed pooled data from two phase III multicenter randomized trials including NDMM patients younger than 65 years (RVMM209: lenalidomide-based induction followed by ASCT vs chemotherapy plus lenalidomide consolidation and subsequent lenalidomide maintenance vs no maintenance; RVMMEMN441: lenalidomide-based induction followed by ASCT vs chemotherapy plus lenalidomide consolidation and subsequent lenalidomide-dexamethasone vs lenalidomide alone maintenance). In both trials, patients randomized to chemotherapy plus lenalidomide consolidation arm (CC group) who experienced progressive disease during treatment were allowed to receive ASCT at relapse. Patients randomized to ASCT consolidation arm (ASCT group) received treatment at relapse at the physician’s discretion. We evaluated PFS1 (time from start of consolidation to 1st relapse), PFS2 (time from start of consolidation to 2nd relapse), and OS (time from randomization at diagnosis to death) through a stratified analysis by protocol. At 1st relapse, 2nd PFS (time from 1st relapse to 2nd relapse) and survival from relapse (time from 1st relapse to death) were evaluated. Intention to treat analysis was performed including patients who were eligible for consolidation.

A subgroup analysis of PFS1, PFS2 and OS in patients who received early ASCT vs ASCT at relapse according to age, gender, protocol, ISS stage, cytogenetic profile and maintenance regimen was conducted.

Results: A total of 791 patients were enrolled in the two trials and 529 were eligible for consolidation: 268 in the ASCT group and 261 in the CC group. Baseline characteristic were equally distributed in the two groups. Median follow-up for survivors was 44.5 months. Early ASCT significantly improved PFS1 (3-year rate: 59% vs 35%, HR 0.48, CI 95% 0.37-0.62, P<0.001) and PFS2 (3-year rate: 77% vs 68%, HR 0.59, CI 95% 0.39-0.89, P=0.012), and marginally OS (4-year rate: 83% vs 72%, HR 0.64, CI 95% 0.38-1.08, P=0.096) in comparison with ASCT at relapse (Figure). 99 patients in the ASCT group experienced 1st relapsed in comparison with 159 patients in the CC group. 42% of patients in the CC group did not receive ASCT at relapse. No differences in 2nd PFS and OS from relapse between patients in the ASCT group or the CC group was noticed. The advantage of early ASCT was also observed when the two trials were analyzed separately and was confirmed in the subgroup analysis.

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[gardengirl]

Re: New study finds early transplantation better than late

by gardengirl on Mon Jun 30, 2014 5:16 am

Is there a way to view the above graphs larger?

[Beacon Staff]

Re: New study finds early transplantation better than late

by Beacon Staff on Mon Jun 30, 2014 5:18 am

Sorry, gardengirl, but that's the original size of the graphs in the abstract. They are not currently available in a larger size (as far as we can tell). Unfortunately, it's not unusual for the graphs accompanying conference abstracts to be relatively small and hard to read.