A randomized trial of 700 patients with multiple myeloma (MM) has found that median progression-free survival is significantly longer in patients who underwent autologous HCT after combination therapy with lenalidomide, bortezomib, and dexamethasone (RVD) than in patients who received RVD alone: 50 months vs. 36 months, respectively (p<0.001).
Patients age <65 years were randomly assigned to receive induction therapy with 3 cycles of RVD and then consolidation therapy with either 5 additional cycles of RVD (n=350) or high-dose melphalan plus autologous HCT followed by 2 additional cycles of RVD (n=350). Patients in both groups received maintenance therapy with lenalidomide for 1 year.
The percentage of patients with a complete response was higher in the HCT group than in the RVD-alone group (59% vs. 48%, p=0.03) as was the percentage of patients in whom minimal residual disease (MRD) was not detected (79% vs. 65%, p<0.001).
However, overall survival (OS) at 4 years did not differ significantly between the HCT group and the RVD-alone group: 81% vs. 82%, respectively (p>0.05). Overall survival was longer (adjusted HR=0.34; p<0.001) for patients without MRD detection, regardless of the treatment group. Successful use of salvage HCT may have contributed to similar OS between groups.
The researchers concluded that “RVD therapy along with transplantation tailored according to minimal residual disease detection could further improve outcomes among adults up to 65 years of age who have multiple myeloma.”