High-Dose Chemotherapy with Early Autologous Stem Cell Transplantation Compared to Standard Dose Chemotherapy or Delayed Transplantation in Patients with Newly Diagnosed Multiple Myeloma: A Systematic Review and Meta-Analysis

Tania Jain, Mohamad Bassam Sonbol, Belal Firwana, Kantha R. Kolla, Diana Almader-Douglas, Jeanne Palmer, Rafael Fonseca

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Autologous stem cell transplantation (SCT) is the standard of care for all transplantation-eligible patients diagnosed with multiple myeloma (MM). Various studies have compared clinical outcomes with frontline SCT (“early SCT”) versus standard-dose therapy (SDT) alone, with or without salvage SCT (“SDT/late SCT”). In this meta-analysis, we compare overall survival (OS) and progression-free survival (PFS) outcomes between these 2 treatment approaches. Twelve studies were identified, including a total of 3633 patients, of whom 1811 received early SCT and 1822 received SDT/late SCT. In our analysis of all 12 studies, OS was not significantly different between the 2 groups (hazard ratio [HR],.86; 95% confidence interval [CI],.70 to 1.04), but PFS was better with early SCT (HR,.67; 95% CI,.54 to.82). In a subgroup analysis of 3 studies in which novel agents were used for induction, OS again was similar in the 2 groups, and PFS was favorable with early SCT (HR,.50; 95% CI,.36 to.70). This analysis shows that over the years, early SCT has been associated with prolonged PFS, but this did not consequently translate into prolonged OS in patients with newly diagnosed MM. The benefit of early SCT in terms of OS is less clear in the era of novel agents, given the limited follow-up of these studies.

Original languageEnglish (US)
JournalBiology of Blood and Marrow Transplantation
DOIs
StateAccepted/In press - Jan 1 2018

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Stem Cell Transplantation
Multiple Myeloma
Meta-Analysis
Transplantation
Drug Therapy
Disease-Free Survival
Survival
Confidence Intervals
Therapeutics
Standard of Care

Keywords

  • Autologous stem cell transplantation
  • Multiple myeloma
  • Standard-dose therapy

ASJC Scopus subject areas

  • Hematology
  • Transplantation

Cite this

@article{2d1935ba49934c3d88587adb6b006554,
title = "High-Dose Chemotherapy with Early Autologous Stem Cell Transplantation Compared to Standard Dose Chemotherapy or Delayed Transplantation in Patients with Newly Diagnosed Multiple Myeloma: A Systematic Review and Meta-Analysis",
abstract = "Autologous stem cell transplantation (SCT) is the standard of care for all transplantation-eligible patients diagnosed with multiple myeloma (MM). Various studies have compared clinical outcomes with frontline SCT (“early SCT”) versus standard-dose therapy (SDT) alone, with or without salvage SCT (“SDT/late SCT”). In this meta-analysis, we compare overall survival (OS) and progression-free survival (PFS) outcomes between these 2 treatment approaches. Twelve studies were identified, including a total of 3633 patients, of whom 1811 received early SCT and 1822 received SDT/late SCT. In our analysis of all 12 studies, OS was not significantly different between the 2 groups (hazard ratio [HR],.86; 95{\%} confidence interval [CI],.70 to 1.04), but PFS was better with early SCT (HR,.67; 95{\%} CI,.54 to.82). In a subgroup analysis of 3 studies in which novel agents were used for induction, OS again was similar in the 2 groups, and PFS was favorable with early SCT (HR,.50; 95{\%} CI,.36 to.70). This analysis shows that over the years, early SCT has been associated with prolonged PFS, but this did not consequently translate into prolonged OS in patients with newly diagnosed MM. The benefit of early SCT in terms of OS is less clear in the era of novel agents, given the limited follow-up of these studies.",
keywords = "Autologous stem cell transplantation, Multiple myeloma, Standard-dose therapy",
author = "Tania Jain and Sonbol, {Mohamad Bassam} and Belal Firwana and Kolla, {Kantha R.} and Diana Almader-Douglas and Jeanne Palmer and Rafael Fonseca",
year = "2018",
month = "1",
day = "1",
doi = "10.1016/j.bbmt.2018.09.021",
language = "English (US)",
journal = "Biology of Blood and Marrow Transplantation",
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T1 - High-Dose Chemotherapy with Early Autologous Stem Cell Transplantation Compared to Standard Dose Chemotherapy or Delayed Transplantation in Patients with Newly Diagnosed Multiple Myeloma

T2 - A Systematic Review and Meta-Analysis

AU - Jain, Tania

AU - Sonbol, Mohamad Bassam

AU - Firwana, Belal

AU - Kolla, Kantha R.

AU - Almader-Douglas, Diana

AU - Palmer, Jeanne

AU - Fonseca, Rafael

PY - 2018/1/1

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N2 - Autologous stem cell transplantation (SCT) is the standard of care for all transplantation-eligible patients diagnosed with multiple myeloma (MM). Various studies have compared clinical outcomes with frontline SCT (“early SCT”) versus standard-dose therapy (SDT) alone, with or without salvage SCT (“SDT/late SCT”). In this meta-analysis, we compare overall survival (OS) and progression-free survival (PFS) outcomes between these 2 treatment approaches. Twelve studies were identified, including a total of 3633 patients, of whom 1811 received early SCT and 1822 received SDT/late SCT. In our analysis of all 12 studies, OS was not significantly different between the 2 groups (hazard ratio [HR],.86; 95% confidence interval [CI],.70 to 1.04), but PFS was better with early SCT (HR,.67; 95% CI,.54 to.82). In a subgroup analysis of 3 studies in which novel agents were used for induction, OS again was similar in the 2 groups, and PFS was favorable with early SCT (HR,.50; 95% CI,.36 to.70). This analysis shows that over the years, early SCT has been associated with prolonged PFS, but this did not consequently translate into prolonged OS in patients with newly diagnosed MM. The benefit of early SCT in terms of OS is less clear in the era of novel agents, given the limited follow-up of these studies.

AB - Autologous stem cell transplantation (SCT) is the standard of care for all transplantation-eligible patients diagnosed with multiple myeloma (MM). Various studies have compared clinical outcomes with frontline SCT (“early SCT”) versus standard-dose therapy (SDT) alone, with or without salvage SCT (“SDT/late SCT”). In this meta-analysis, we compare overall survival (OS) and progression-free survival (PFS) outcomes between these 2 treatment approaches. Twelve studies were identified, including a total of 3633 patients, of whom 1811 received early SCT and 1822 received SDT/late SCT. In our analysis of all 12 studies, OS was not significantly different between the 2 groups (hazard ratio [HR],.86; 95% confidence interval [CI],.70 to 1.04), but PFS was better with early SCT (HR,.67; 95% CI,.54 to.82). In a subgroup analysis of 3 studies in which novel agents were used for induction, OS again was similar in the 2 groups, and PFS was favorable with early SCT (HR,.50; 95% CI,.36 to.70). This analysis shows that over the years, early SCT has been associated with prolonged PFS, but this did not consequently translate into prolonged OS in patients with newly diagnosed MM. The benefit of early SCT in terms of OS is less clear in the era of novel agents, given the limited follow-up of these studies.

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