Salvage therapy versus upfront autologous stem cell transplantation in multiple myeloma patients with progressive disease after first-line induction therapy

Abstract

It is a matter of debate whether myeloma patients with progressive disease (PD) after induction should receive salvage therapy or proceed directly to autologous stem cell transplantation. We performed a retrospective analysis of 1599 patients treated between 1991 and 2016 at the University Hospital of Heidelberg and other centers. Deepening of response through salvage therapy did not lead to better progression-free or overall survival (PD versus salvage therapy patients: HR = 0.71, 95% CI [0.28, 1.80], p = 0.5 and HR = 0.77, 95% CI [0.30, 1.95], p = 0.6, respectively), neither in patients treated with novel agents (HR = 0.66, 95% CI [0.23, 1.85], p = 0.4 and HR = 0.76, 95% CI [0.27, 2.15], p = 0.6) nor older regimens (HR = 0.86, 95% CI [0.36, 2.07], p = 0.7 and HR = 0.8, 95% CI [0.34, 1.91], p = 0.6). Therefore, primary nonresponders might benefit from a direct transplant rather than salvage induction, although the analyzed salvage therapy cohort was small (n = 23) and cytogenetics was not included in the multivariable analysis.

Keywords:

• Multiple myeloma
• salvage therapy
• autologous stem cell transplantation

Disclosure statement

Joanna Blocka and Thomas Hielscher have no relevant conflicts of interest to disclose. Carsten Mueller-Tidow has served on advisory boards with Janssen. Hartmut Goldschmidt received research support to the institution from Amgen, Bristol-Myers Squibb, Celgene, Chugai, Janssen, Mundipharma, Novartis, Sanofi, and Takeda, has served on advisory boards with Adaptive Biotechnology, Amgen, Celgene, Janssen, Sanofi, and Takeda, and received honoraria from ArtTempi, Bristol-Myers Squibb, Celgene, Chugai, Janssen, and Novartis. Jens Hillengass has served as a consultant to Amgen and Celgene, received honoraria from Amgen, Bristol-Myers Squibb, Celgene, Janssen, Novartis, and Takeda, received research funding from Celgene and Sanofi as well as has served on advisory boards with Amgen, Bristol-Myers Squibb, Celgene, Janssen, and Novartis.