We continue to report the latest myeloma-related findings from this year’s American Society of Hematology (ASH) meeting, which has come to a close in Atlanta.  Yesterday was the third day of the meeting and featured the most myeloma-related presentations in a given day.

Yesterday, there were nearly 50 myeloma-related talks given during 11 oral presentation sessions.  The Beacon will therefore summarize presentations from the four most important sessions in updates such as this one.

This update covers presentations from the third of the four key oral presentation sessions. Updates published yesterday ^[1] and this morning ^[2] cover presentations from the first two sessions, and updates to be published later today and tomorrow will cover the remaining key oral presentation session as well as a poster session held yesterday evening.

The early afternoon oral presentation session, which focused on stem cell transplantation, will be discussed in this update.

One of the presentations investigated trends in the utilization of stem cell transplantation for multiple myeloma. The researchers found an increase in survival over the past 15 years for newly diagnosed patients who have received transplants. The researchers believe that there are two main factors that could account for the increased survival:  the increased use of novel agents as induction therapy and a switch from a variety of pre-transplantation chemotherapy regimens to almost completely just high-dose melphalan ^[3] (Alkeran) - a switch that occurred primarily in the last ten years.

In another study presented during the session, researchers investigated the question of whether patients who fail to respond to initial therapy should be treated longer before moving on to stem cell transplantation.  The researchers did not find any difference in survival after transplantation between patients who received additional therapy and those who did not.  Based on these findings, it is not clear that further treatment of patients who do not achieve a complete response prior to a transplant is better than just giving them the transplant regardless of their response to initial therapy.

In another talk, French researchers presented a new simple scoring system that may be helpful in predicting survival of newly diagnosed patients undergoing stem cell transplantation.

Trends In Utilization Of Stem Cell Transplantation For Multiple Myeloma

Dr. Luciano Costa from the Medical University of South Carolina presented results from an analysis investigating trends in the utilization of stem cell transplantation for multiple myeloma in the United States and Canada between 1999 and 2010 (abstract ^[4]; presentation slide deck ^[5] (pdf) made available by Dr. Costa and the CIBMTR ^[6] as a courtesy to the Beacon’s readers).

The analysis included data from 20,278 multiple myeloma patients who underwent stem cell transplantation within 12 months of their diagnosis. Patients were divided into three groups based on the time when they received their transplants: 1995 to 1999 (2,226 patients), 2000 to 2004 (6,408 patients), and 2005 to 2010 (11,644 patients).

The results showed that the share of patients who were older than 65 years has increased over the years, from 8 percent in the first time period to 24 percent in the third time period.

The use of novel agents, such as thalidomide ^[7] (Thalomid), Velcade ^[8] (bortezomib), and Revlimid ^[9] (lenalidomide), as initial therapy before stem cell transplantation has significantly increased over the three time periods: Thalidomide (less than 1 percent versus 22 percent versus 52 percent); Velcade (0 percent versus 2 percent versus 35 percent); Revlimid (0 percent versus 1 percent versus 21 percent).

The use of single-agent melphalan ^[3] (Alkeran) as part of the transplant increased from 54 percent during the first time period to nearly 100 percent in the later two time periods.  In most cases, it replaced total body irradiation-based therapies and multi-drug regimens.

Five-year overall survival rates increased over the three time periods (47 percent versus 52 percent versus 55 percent).

After relapse, four-year survival was also better for patients who received a transplant in the later time periods (33 percent versus 39 percent versus 40 percent).

The use of maintenance therapy has also changed over time, with 27 percent of patients receiving interferon during the first time period, compared to 23 percent receiving thalidomide, Velcade, or Revlimid during the most recent time period.

Pre-Transplant Salvage Therapy

Next, Dr. Ravi Vij from the Washington University School of Medicine in Saint Louis, Missouri, presented findings from an analysis investigating the use of stem cell transplantation in myeloma patients who failed to respond to their initial therapy (abstract ^[10]; presentation slide deck ^[11] (pdf) made available by Dr. Vij as a courtesy to the Beacon’s readers).

Specifically, the researcher investigated whether post-stem cell transplant outcomes were better if these patients received additional therapy, called salvage therapy, prior to undergoing stem cell transplantation.

The analysis was based on data from 575 multiple myeloma patients who had received a stem cell transplant within 12 months of their diagnosis after not responding to their initial therapy; 56 percent had received salvage therapy before the transplant.

The researchers found that salvage therapies increased the depth of response before the transplant.

However, the six-year non-relapse death rates, relapse rates, progression-free survival, and overall survival did not differ between the two patient groups.

Based on their findings, the researchers concluded that salvage therapies before stem cell transplantation do not offer any additional benefits.

New Scoring System To Predict Survival After Stem Cell Transplantation

The final myeloma-related presentation during the early afternoon session was given by Dr. Philippe Moreau from the University Hospital Hôtel-Dieu in Nantes, France. Dr. Moreau reported the results from an analysis that sought to determine a group of myeloma patients who are at high risk of disease progression after stem cell transplantation (abstract ^[12]).

Dr. Moreau and his colleagues therefore retrospectively analyzed data from newly diagnosed multiple myeloma patients who received a stem cell transplant after initial therapy with novel agents.

In their analysis, the researchers found that advanced disease, high levels of the enzyme lactate dehydrogenase (LDH), and the presence of the chromosomal abnormalities t(4;14) or del(17p) were associated with a high risk of disease progression.

Based on these factors, the researchers developed a new scoring system that predicts overall survival. Patients with the lowest score, which corresponds to having none of the risk factors, had the highest three-year overall survival rate (84 percent), whereas patients with the highest score, which corresponds to having the chromosomal abnormalities plus at least one additional risk factor, had the lowest three-year survival rate (24 percent).

Myeloma presentations from the rest of Day 3 as well as Day 4 of the ASH 2012 meeting also will be summarized in ASH daily updates to be published at The Beacon the next few days.  Additional coverage of key research results from the meeting will continue throughout the rest of the week in individual, topic-specific news articles.  For all Beacon articles related to this year’s ASH meeting, see The Beacon’s full ASH 2012 ^[13] coverage.