TY - JOUR
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
N1 - Publisher Copyright:
© 2018 American Society for Blood and Marrow Transplantation
PY - 2019/2
Y1 - 2019/2
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.
KW - Autologous stem cell transplantation
KW - Multiple myeloma
KW - Standard-dose therapy
UR - http://www.scopus.com/inward/record.url?scp=85055551737&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85055551737&partnerID=8YFLogxK
U2 - 10.1016/j.bbmt.2018.09.021
DO - 10.1016/j.bbmt.2018.09.021
M3 - Article
C2 - 30244101
AN - SCOPUS:85055551737
SN - 1083-8791
VL - 25
SP - 239
EP - 247
JO - Biology of Blood and Marrow Transplantation
JF - Biology of Blood and Marrow Transplantation
IS - 2
ER -