The article summarizes data from a single treatment center in Hungary. The authors went back and put together data on almost 550 myeloma patients who, over the past 18 years, had received either an early or a late stem cell transplant.
Now, patients almost 20 years ago were not getting the same frontline therapy that patients today are getting. No Velcade for induction therapy in 2000, for example. There was, however, one other interesting variation in the treatments patients received. Some of the patients received interferon as maintenance therapy, while others did not.
The authors found that there was the expected impact on progression-free survival of having an early versus late stem cell transplant, but no impact on overall survival. This finding was the same for patients treated early in the sample and later in the sample -- access to novel therapies didn't seem to matter.
Here is what was really interesting, however. Patients who were treated with interferon maintenance therapy had overall survival that was more than 5 years longer than patients who did not receive the treatment.
Yes, a difference of 5 YEARS in overall survival.
Remember, this is a single-center, retrospective study. Patients were not randomly allocated to get interferon or not get interferon, or to get early versus late transplants. So you have to be very careful in interpreting the results.
Interferon is not an easy drug to tolerate, so it's entirely possible, for example, that only healthier patients were given it as maintenance therapy, and healthier patients were more likely to live longer.
But, still...5 years difference in overall survival. That's makes you sit up and pay attention.
I'll also mention that the journal the article appears in is not one of the higher reputation journals, so maybe there are issues with how the authors did some of their calculations.
In any cases, here is a link to the study:
P. Remenyi et al, "Early Versus Delayed Autologous Stem Cell Transplantation and Interferon Maintenance in Multiple Myeloma: Single-Center Experience of 18 Years", Transplantation Proceedings, Jan-Feb 2016 (abstract)
and here are the highlights and abstract:
Highlights
- Our results show that progression-free survival is significantly longer after early than after delayed autologous stem cell transplantation (ASCT) in multiple myeloma.
- We found no difference in overall survival between early and delayed ASCT.
- Patients treated with interferon maintenance benefited in both progression-free and overall survival.
- Our findings demonstrate that delayed ASCT can be feasible in selected patients.
Background - Autologous stem cell transplantation (ASCT) has become the mainstay of 1st-line treatment in younger patients with multiple myeloma, but statistical confirmation of its superiority over other therapies, especially in the era of novel agents, is still lacking.
Methods - We reviewed the results of all 548 myeloma ASCTs performed in our institute over the past 18 years.
Results - More than one-half of the patients had access to novel agents before their transplantations. Although the age of the transplanted patients increased significantly over the years, treatment-related mortality (TRM) was remarkably low, especially in 1st-line transplanted patients (100-day TRM, 0.3%). The median overall survival (OS) of the entire cohort was 98.4 months. Patients transplanted within 12 months from the start of their therapy had significantly better responses than those having delayed ASCT (complete response rate, 58.1% vs 46.8%; P = .016) and significant post-ASCT progression-free survival (PFS) benefit (30.2 [26.1–34.3] mo vs 23.3 [16.8–29.8] mo; P = .036), but we found no significant overall survival difference. The results were similar in patients treated with or without novel agents before ASCT. During a period of time, interferon maintenance was our standard approach to post-ASCT maintenance. Our analysis showed not only a significant PFS advantage with interferon, but also a highly significant overall survival benefit (150.4 [105.1–195.8] mo vs 86.1 [72.5–99.7] mo; P = .003).
Conclusions - Our findings demonstrate that delayed ASCT can be feasible in selected patients.
