Comparing Tandem Stem Cell Transplant Approaches in Multiple Myeloma

Nicolaus Kröger, MD, a professor and medical director of the Department of Stem Cell Transplantation, University Hospital Hamburg-Eppendorf, Hamburg, Germany, discusses the advantages of autologous stem cell transplant and allogeneic stem cell transplant (auto-allo) compared with autologous tandem transplant (auto-auto) in patients with multiple myeloma.

Kröger says the major advantage of using the auto-allo approach in the prospective, phase 2 study (NCT00777998) was that patients had a lower risk of relapse. The incidence of relapse for the auto-allo group was significantly lower than the auto-auto group. Both arms were given thalidomide (Thalomid) maintenance therapy after tandem transplant.

The benefit with auto-allo was partly overshadowed by a higher non-relapse mortality with auto-allo, at 13%, versus auto-auto, at 2%. This was a significant difference. There was still a risk of non-relapse mortality in patients receiving auto-allo, which is why this type of treatment has not become the standard of care in newly-diagnosed multiple myeloma, according to Kröger.

Patients with high-risk disease, such as those with deletion 17p, for example, might benefit from the auto-allo treatment approach, Kröger says. In this trial, about 10% of patients had high-risk disease, and although there was a trend towards improved survival with auto-allo, the number of patients was not large enough for this benefit to be significant.