Results from a new study presented at the 16th Congress of the European Hematology Association in London (United Kingdom) shows possible advantages of stem cell transplantation for patients with Multiple Myeloma, a cancer of plasma cells. Dr Antonio Palumbo: “This study shows a longer progression-free survival time with hematopoietic stem cell transplantation in comparison to conventional chemotherapy.”

Multiple myeloma is the second most common hematologic malignancy, with a higher incidence in patients over 65 years. Although the disease remains incurable, the introduction of novel agents, such as the immunomodulatory drugs thalidomide (Thalomid®, Celgene) and lenalidomide (Revlimid®, Celgene) and the proteasome inhibitor bortezomib (Velcade®, Millennium Pharmaceuticals), has significantly changed the treatment paradigm of this disease and considerably improved outcomes. High-dose therapy is considered the standard treatment for younger patients, while older patients benefit more from a gentler approach.

Commenting on the trial results, Antonio Palumbo, M.D., from the Division of Hematology of the University of Torino, Azienda Ospedaliero-Universitaria San Giovanni Battista di Torino in Italy said ?We have compared the role of high-dose chemotherapy (MEL 200) followed by hematopoietic stem cell transplantation with novel agents versus conventional chemotherapy with novel agents.

The available literature on melphalanprednisone plus novel agents suggested that novel agent-containing regimens might have the same impact on response rate as hematopoietic stem cell transplantation. Therefore, in our study we compared high dose melphalan MEL 200 followed by hemaotopoietic stem cell transplantation versus conventional melphalan-prednisone plus the novel agent lenalidomide (MPR) in patients with newly diagnosed multiple myeloma who received induction treatment with lenalidomide and low-dose dexamethasone.

Despite comparable response rates between the two arms, MEL200 showed a longer progression-free survival. This is the first study showing a longer progression-free survival time with hematopoietic transplantation with novel agents in comparison to conventional chemotherapy with novel agents. To date, it is not possible to assess the impact of either approach on overall survival, and longer follow-up is needed to draw any definitive conclusions. Our results also confirmed that in the era of novel agents, high-dose chemotherapy followed by hematopoietic stem cell transplantation remains the essential strategy in younger patients with multiple myeloma.

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