ASH 2020 | ASCT in relapsed myeloma patients
Surbhi Sidana, MD, Stanford University, Stanford, CA, discusses the results of a retrospective study of outcomes of autologous stem cell transplant (ASCT) in patients with relapsed multiple myeloma. Some patients chose to undergo ASCT at relapse instead of as upfront therapy, so overall survival (OS) of 168 relapsed myeloma patients was recorded. The impact of PFS from first-line therapy on survival was analyzed, as well as multivariate analysis for PFS and OS adjusting for cytogenetics, use of maintenance, Karnofsky performance status, and relapse number. The study provides important expected outcomes data and prognostic factors for relapsed myeloma patients undergoing ASCT. This interview took place during the 62nd American Society of Hematology (ASH) Annual Meeting and Exposition, 2020.
Transcript (edited for clarity)
There is a lot of data available for outcomes with autologous stem cell transplantation in patients undergoing transplant with newly diagnosed myeloma after induction therapy, but there is limited data available for relapsed patients, and the data that is out there for relapsed patients includes the majority of patients have had a prior transplant. Now in 2020, and in the years before and after, several patients may elect to delay transplant, because of all the wonderful induction and maintenance therapies we have, and data from the IFM trials showing early versus delayed transplant results in similar overall survival...
There is a lot of data available for outcomes with autologous stem cell transplantation in patients undergoing transplant with newly diagnosed myeloma after induction therapy, but there is limited data available for relapsed patients, and the data that is out there for relapsed patients includes the majority of patients have had a prior transplant. Now in 2020, and in the years before and after, several patients may elect to delay transplant, because of all the wonderful induction and maintenance therapies we have, and data from the IFM trials showing early versus delayed transplant results in similar overall survival. And therefore there is limited data in patients undergoing transplant at relapse, who didn’t undergo a transplant before.
So what we did was we looked at patients at Stanford University who underwent a transplant at relapse. There were 168 patients and importantly, 80% of them had not had a prior transplant, and 70% of them were undergoing transplant at first relapse in this group. So when we looked at all 168 patients, the median progression-free survival was 28 months, and the median overall survival, again, this is from start of therapy for relapsed disease was 69 months. When you look at median overall survival from the time of diagnosis, that was almost 10 years, which is very encouraging.
But when we specifically looked at our subgroup of patients who underwent their first transplant at relapse, so called, “delayed first transplant,” their median progression-free survival was about 30 months, and their median overall survival was 69 months. So close to about six years. And this is again from start of therapy for relapsed disease. One thing to note is that only a third of these patients got maintenance therapy. So for someone we are seeing in clinic today, we would expect the survival outcomes to be much better, as most patients now in 2020 are getting maintenance therapy. So these data can help inform patients when they come to transplant for relapse disease, to counsel them for expected outcomes, and these data can also serve as a benchmark, when we design trials for transplant, especially delayed first transplant at the time of relapse, compared to other novel therapies in the current era.
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