New approach to multiple myeloma shows greatly improved survival

By John Murphy, MDLinx
Published February 9, 2016

Key Takeaways

An innovative regimen for treating multiple myeloma resulted in 62% overall survival and 41% progression-free survival at 10 years, according to a study reported online December 21, 2015, in Bone Marrow Transplantation. These results are a substantial improvement over the current relative survival rate for multiple myeloma, which is 47% for 5 years.

The approach used in this study consists of an autologous hematopoietic stem cell transplantation (HSCT) followed 3 to 4 months later by an outpatient non-myeloablative allogeneic HSCT from a family donor.

“In many hospitals, doctors have abandoned the use of allografts for multiple myeloma due to the risk of toxicity and relapse. Our results, on the other hand, have led us to offer the treatment to more patients, especially younger patients and those with poorer prognoses,” said the study’s lead investigator Jean Roy, MD, Associate Professor of Medicine at the University of Montreal and Head of Hematology and Oncology at Maisonneuve-Rosemont Hospital, in Montreal, Canada.

Dr. Roy and colleagues pursued this “tandem approach” after previous research with non-myeloablative allogeneic (NMA) conditioning showed a positive result. That earlier research resulted in a high incidence of chronic graft-vs-host disease, but low incidences of acute graft-vs-host disease and non-relapse mortality.

“We therefore hypothesized this particularly light NMA regimen would be optimal to promote a graft-versus-myeloma effect in newly diagnosed multiple myeloma patients,” the authors wrote.

Between 2001 and 2010, the researchers used the regimen on 92 newly diagnosed patients (median age 52). After a median follow-up of 8.8 years, more than 40% of the 92 patients are long-term survivors without evidence of progression; these patients “may be cured,” the authors concluded.

Although the cumulative incidence of extensive chronic graft-vs-host disease was high (79%), the majority of long-term survivors were off immunosuppressive drugs in 5 years, and non-relapse mortality was a “remarkably low” 10%, the authors reported.

The researchers are now conducting a new study to refine this regimen and further reduce rates of relapse and complications.

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