A multi-center randomized trial of 700 patients <65 years old with de novo multiple myeloma (MM) has shown that autologous hematopoietic cell transplantation (HCT) following treatment with lenalidomide, bortezomib and dexamethasone (RVD) is better than treatment with these drugs alone. Researchers compared outcomes of MM patients receiving conventional dose treatment (8 cycles of RVD) with patients treated with RVD followed by autologous HCT. Patient characteristics of each group were comparable, and both arms received 1 year of lenalidomide maintenance. After a median follow up of 39 months, 3-year progression-free survival was significantly higher in the transplant arm compared to the RVD-only arm: 61% vs. 48%, respectively (stratified p value by log-rank test <0.0002; 95% CI=1.2-1.9). The complete response rate was also significantly higher in the transplant arm compared to the RVD-only arm: 58% vs. 46%, respectively (p<0.01). The researchers concluded that autologous HCT should remain a standard of care for patients <65 years with de novo MM.
Autologous Transplantation for Multiple Myeloma in the Era of New Drugs