ASH 2018: One Myeloma Transplant vs. Two? That is the Question

As long as I have a member of the myeloma patient community there has always been discussion of the role of transplant as well as the number of transplants.  Two prior studies had shown exactly opposite conclusions. Both study had differing designs, however both had elements of Velcade/Revlimid/Dex (VRD) induction, and as have previously found it to be a better response than Vincristine/Doxorubicin/Dex (VAD) or Revlimid/Dex (RD).  

 

So the data was sliced and diced to make it as comparable as it could be, and then both studies were consolidated into one.   Michele Cavo, MDN, Professor of Hematology Bologna University School of Medicine, Head of Myeloma Research Unit, Seràgnoli Institute of Hematology Bologna, Italy presented the following abstract.

Double Vs Single Autologous Stem Cell Transplantation for Newly Diagnosed Multiple Myeloma: Long-Term Follow-up (10-Years) Analysis of Randomized Phase 3

 

The design of the studies was as noted in the picture below:

 

Some of the key results are noted in the next two images:

 

 

 

 

As can be noted, an amazing overall survival difference exists in favor of two transplant over one for the high risk group.  So it appears transplant is not dead nor is the use of two transplants.  Dual transplant provides a 7 plus year overall survival vs. 4 for the single transplant.  Looks like we won’t be done with transplant any time soon.