Survival outcomes following autologous stem cell transplant with melphalan 140mg/m² versus 200mg/m² preparative regimens in patients with multiple myeloma

Abstract

The standard preparative regimen for autologous stem cell transplant (ASCT) in multiple myeloma (MM) is 200 mg/m² of intravenous melphalan; however, a dose of 140 mg/m² is often used when concerns exist related to patient age, performance status, organ function, and other factors. It is unclear whether a lower dose of melphalan impacts post-transplant survival outcomes. We performed a retrospective review of 930 patients with MM who underwent ASCT with 200 mg/m² versus 140 mg/m² melphalan. On univariable analysis, no difference in progression-free survival (PFS) was observed, however, an overall survival (OS) benefit was observed in patients receiving 200 mg/m² melphalan (p = 0.04). Multivariable analyses showed patients receiving 140 mg/m² faired no worse than those receiving 200 mg/m². While a subset of younger patients with normal renal function may achieve superior OS with a standard dose of 200 mg/m² melphalan, these findings suggest an opportunity to individualize the ASCT preparative regimen to optimize outcomes.

Keywords:

• Multiple myeloma
• autologous stem cell transplant
• conditioning regimen

Ethics statement

The study was conducted in accordance with the institutional guidelines with the approval of the institutional review board (2019E0065).

Patient consent

Patient consent was waived, as this was a retrospective chart review study.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

The data presented in this study are available on request.

Additional information

Funding

This research received no external funding.