A recent study published in Scientific Reports investigates the efficacy of tandem autologous stem cell transplantation (ASCT) compared to single ASCT in patients with multiple myeloma (MM). The research highlights potential benefits of tandem ASCT, particularly in high-risk subgroups and those not achieving complete remission after the initial transplant.
Tandem ASCT Improves PFS in High-Risk Myeloma
The study compared outcomes of patients undergoing single versus tandem ASCT, focusing on progression-free survival (PFS) and overall survival (OS). While overall, no significant differences were observed in PFS or OS between the entire groups, subgroup analyses revealed notable advantages for tandem ASCT in specific populations.
Patients with International Staging System (ISS) III disease at diagnosis showed a significantly longer median PFS with tandem ASCT compared to single ASCT (23.1 vs. 14.7 months, p = 0.007). Similarly, in patients with high-risk fluorescence in situ hybridization (FISH) results, tandem ASCT was associated with superior PFS (21.7 vs. 13.2 months, p = 0.042).
Benefits for Non-Complete Responders
Further analysis focused on patients who did not achieve a complete response (CR) after their first ASCT. In this group, tandem ASCT led to a significantly longer PFS compared to single ASCT (20.3 vs. 12.6 months, p = 0.003), suggesting that a second transplant can overcome initial treatment resistance.
Multivariate Analysis Confirms Tandem ASCT Benefit
Multivariate Cox regression analyses, adjusting for maintenance therapy, revealed that tandem ASCT was independently associated with improved PFS in patients with ISS III disease and high-risk FISH. This suggests that the benefit of tandem ASCT is not solely due to patient selection or other confounding factors.
Propensity Score Matching Reinforces Findings
To address potential biases arising from the retrospective nature of the study, propensity score matching was employed. This analysis confirmed that tandem ASCT was significantly associated with improved PFS (30.3 vs. 13.5 months, p = 0.028), further supporting the potential of tandem ASCT in select MM patients.
Safety Profile
The study also assessed the safety of tandem ASCT. While grade ≥3 anemia was more frequent in the tandem ASCT group, non-hematological toxicities and rates of febrile neutropenia were similar between the two groups. There was no significant difference in toxicity between the first and second tandem transplants. The 100-day mortality was numerically higher in the tandem group (11 vs 6 patients), primarily due to disease progression.
Implications for Myeloma Treatment
These findings suggest that tandem ASCT may offer a valuable treatment strategy for specific subgroups of MM patients, particularly those with high-risk disease or those who do not achieve a complete response after initial ASCT. Further prospective studies are warranted to validate these findings and to better define the optimal role of tandem ASCT in the evolving landscape of myeloma therapy.
