ASH 2016: The Continuing Case for Stem Cell Transplant in Myeloma

While new treatments (like immunotherapies) are the hot new thing in blood cancers, there was a surprisingly equal discussion at this year's ASH 2016 meeting in San Diego about the continuing important role of stem cell transplant. According to Dr. Philip McCarthy who was part of the main myeloma session, transplant is not going away any time soon. In one key ASH session, Dr. Michele Cavo showed that up front transplant is still the best approach, even in the age of new treatment options. He cited a phase III study of 1510 newly diagnosed myeloma patients that compared the combination of Velcade/melphalan/prednisone (VMP) vs. two rounds of melphalan followed by a single or double stem cell transplant followed by lenalidomide maintenance until progression. The rate of high-risk myeloma was similar in all groups (about 25%). Progression free survival at 26 months was as follows:

• VMP combination: 44 months (With a 57% 3 year estimate)
• High Dose Melphalan: Not yet reached (With a 66% 3 year estimate)

The benefit was seen for all stages of disease and for standard as well as high risk features. The odds of getting a very good partial response was 76% in the VMP group and 85% in the high dose melphalan group. Dr. Cavo said about the study:

"Results of this phase III study, the largest so far reported, support the conclusion that upfront ASCT still continues to be the reference treatment for fit patients with [newly diagnosed multiple myeloma], even in the novel agent era."

According to MedPage today, Mehdi Hamadani, MD, of the Medical College of Wisconsin in Milwaukee, co-moderated a session on stem cell transplant and mentioned that the excitement around new therapies was justified but it is still too early stop performing stem cell transplants.

"We don't have good enough data to conclude that transplants are dispensable," he said. He noted that most trials looking at the issue have been powered to evaluate PFS, adding that he's looking forward to seeing meta-analyses that will allow determination of overall survival. So far, "we continue to see better disease control with transplant," he said.