Autologous Stem Cell Transplant for Multiple Myeloma: Benefits and Patient Selection

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• Transplant in Myeloma Treatment
• Defining Young Patients
• DFCI Study Results
• Transplant Survival Benefit
• Treatment for Older Patients
• Individual Treatment Decisions
• Full Transcript

Transplant in Myeloma Treatment

Autologous stem cell transplantation is an established frontline therapy for multiple myeloma. Dr. Nikhil Munshi, MD, confirms its role in treating younger, fit patients with newly diagnosed disease. This treatment approach fits within the current spectrum of multiple myeloma treatment options.

The procedure involves high-dose chemotherapy followed by infusion of the patient's own stem cells. This aggressive treatment aims to achieve deeper and more durable remissions.

Defining Young Patients

Patient age for transplant eligibility is more about physical condition than numerical age. Dr. Nikhil Munshi, MD, explains that while 70 is often used as an artificial cutoff, biological age matters more. Some patients in their early seventies have the physical state of someone much younger.

These fit older patients can sometimes be treated as if they were younger when considering transplant. Fitness assessment includes evaluating organ function, performance status, and comorbidities.

DFCI Study Results

The recent DFCI Determination study provided crucial evidence for transplant benefits. Dr. Nikhil Munshi, MD, discusses this IFM DFCI combined study involving 722 patients. Researchers used a state-of-the-art three-drug regimen of lenalidomide, bortezomib, and dexamethasone.

This combination therapy achieves nearly 100% response rates in multiple myeloma. The study evaluated whether transplant still provides additional benefit despite these effective drugs.

Transplant Survival Benefit

Transplant demonstrated significant progression-free survival advantages in the DFCI study. Dr. Nikhil Munshi, MD, reports approximately two years longer progression-free survival for transplant patients. This benefit was observed even with excellent three-drug regimen responses.

The study results, presented recently, confirm transplant's ongoing importance. Multiple similar studies have established that transplant provides meaningful clinical benefits for eligible patients.

Treatment for Older Patients

For patients where transplant risks outweigh benefits, effective alternatives exist. Dr. Nikhil Munshi, MD, notes that the same three-drug regimen works well for older populations. This treatment achieves approximately 50% complete response rates in older multiple myeloma patients.

These outcomes represent very good results for patients who cannot undergo transplant. Treatment selection always involves balancing potential benefits against possible risks.

Individual Treatment Decisions

Multiple myeloma treatment requires personalized decision-making between physicians and patients. Dr. Nikhil Munshi, MD, emphasizes that transplant remains the treatment of choice when feasible. This is particularly true for fitter, younger patients with newly diagnosed disease.

Dr. Anton Titov, MD, facilitates this discussion by exploring current treatment paradigms. The conversation between Dr. Titov and Dr. Nikhil Munshi, MD, highlights the importance of individualized care in oncology.

Full Transcript

Dr. Anton Titov, MD: Let's discuss treatment of multiple myeloma. Autologous stem cell transplant is an established frontline therapy for younger patients with newly diagnosed multiple myeloma. Where does stem cell transplantation fit in the current treatment options for multiple myeloma?

Dr. Nikhil Munshi, MD: So what you say about younger patients—young is very relative. Who is young? Usually, you would say someone young is somebody who is one year older than me or something. The definition of young is more physical than numeric. Artificial cutoff ends up being 70 years.

But we have patients who are 73 or 74, but their physical state is like 64. And we do treat them sometimes as 64 in considering treatments like transplant.

So back to your original question: yes, patients who are fit enough or young are still good candidates for transplant.

We had a presentation very recently from our own group, what was called the DFCI Determination study. It's an IFM DFCI combined study in 22 patients. We utilized state-of-the-art three-drug regimen: lenalidomide, bortezomib, dexamethasone.

Then we evaluated if transplant gives benefit or not, because these three-drug regimens get 100% response rates. So would transplant be beneficial?

In our study just presented less than a month ago—literally two weeks ago—for the first time, those results were presented. Although our eventual final result is well known, the transplant still provides significant benefit despite having very good other treatments.

In our study, we had close to two years higher progression-free survival in patients who got transplant versus those who did not.

So that study and many other similar studies have established that in patients who are in physically good health, they can and should remain candidates for high-dose chemotherapy. An individual decision needs to be taken by physicians and patients.

But we do offer transplant earlier on to all this patient population when they can get it. For patients who are older, where we would feel that the risk of transplant outweighs the benefit, then there are very good drugs also. The same three-drug regimen provides almost 50% complete response rate, and that's a very good outcome also for older patient populations.

But when feasible, stem cell transplant remains a treatment of choice upfront in fitter, younger patients.