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Progression-free survival (PFS) and overall survival (OS) advantages for transplant-eligible patients with multiple myeloma (MM) have been shown with single-cycle melphalan 200mg/m2 and autologous hematopoietic cell transplantation (AHCT) followed by lenalidomide (len) maintenance, which is the standard of care for patients in the United States (US).
Edward A. Stadtmauer, from Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA, Marcelo C. Pasquini from Medical College of Wisconsin, Wisconsin, US, and colleagues, conducted a randomized, three-arm, phase III trial (BMT CTN 0702; NCT01109004) across 54 transplantation centers in the US. The aim was to assess whether any further PFS and OS benefit can be provided from more intensive interventions such as second AHCT or consolidation with combinations of immunomodulatory agents, proteasome inhibitors or corticosteroids.
All data is given as AHCT/AHCT + len arm vs AHCT + RVD + len arm vs AHCT + len arm:
This phase III study has shown no additional benefit in PFS or OS over 38 months when more intensive treatment approaches, such as second AHCT or RVD + len maintenance cycles, are used. Therefore, in the transplant-eligible patient population, initial therapy of multidrug induction with AHCT consolidation and maintenance should remain as the standard approach.
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