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Tandem Meetings 2023 | The benefit of autologous transplantation in the era of novel agents in multiple myeloma

Muzaffar Qazilbash, MD, The University of Texas MD Anderson Cancer Center, Houston, TX, explains why autologous stem cell transplantation (autoSCT) remains a key element of most treatment algorithms in multiple myeloma despite novel agents becoming increasingly available. Prof. Qazilbash explains that although novel agents are highly effective, they still haven’t led to a cure for multiple myeloma. High-dose melphalan followed by autoSCT is a highly effective method that always adds a progression-free survival (PFS) benefit when added to different regimens. In addition, it is cost-effective and well-tolerated overall. This interview took place at the 2023 Transplantation & Cellular Therapy Meetings of ASTCT™ and CIBMTR® held in Orlando, FL.

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Transcript (edited for clarity)

As you know, being in a stem cell transplant, I always get asked this question. And there are a couple of simple answers. One, that despite the availability of all novel agents, we are not curing myeloma. So even with all these treatments we have basically and which is great progress, we have deepened the response. We have increased the durability and the duration of responses. But none of these combinations just by themselves have led to any cure or a plateau in survival curves...

As you know, being in a stem cell transplant, I always get asked this question. And there are a couple of simple answers. One, that despite the availability of all novel agents, we are not curing myeloma. So even with all these treatments we have basically and which is great progress, we have deepened the response. We have increased the durability and the duration of responses. But none of these combinations just by themselves have led to any cure or a plateau in survival curves.

The other very important reason why transplant is still considered part of upfront treatment for myeloma is that whenever these regimens, whether it is VRD or KRD and now with dara-VRD or dara-VTD, when they are combined with high dose melphalan and autologous stem cell transplant, they always led to an improvement in progression-free survival, improvement in depth of response and now improvement in MRD-negative status. So until something does better than stem cell transplant or high dose melphalan, it is very much a part of the treatment because it does benefit patients. So overall, they have a longer duration of remission and they have a deeper response.

And in addition, high dose melphalan and autologous stem cell transplant compared to many newer drugs is a reasonably cost-effective treatment. And we’ve also learned so much about it that it’s a very safe treatment, and treatment related mortality is practically zero. So the reason it is very much part of all treatment algorithms is that it works, it’s effective, it’s reasonably safe. And even when combined with all the newer agents, it actually adds to the benefit. And because of all these reasons, it’s still very much part of the algorithm because the data support that.

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