Melphalan Plus Stem Cell Transplant in Multiple Myeloma


A new study in the New England Journal of Medicine makes a convincing case for stem cell transplant in Multiple Myeloma patients.

Italian researchers conducted an open label, randomized phase III study with 273 patients 65 or younger comparing the drug melphalan (200 mg per square meter of body-surface area) plus autologous stem cell transplantation with melphalan-prednisone-lenalidomide (MPR).

They also compared lenalidomide maintenance therapy with no maintenance therapy in 251 patients.

All patients had newly diagnosed multiple myeloma.

The primary end point was progression free survival, and the median follow-up period was 51.2 months.

Their conclusions:

  • Progression free survival was much better in patients receiving high-dose melphalan plus stem cell transplant than they were in patients receiving MPR: 43.0 months vs. 22.4 months.
  • Overall survival was better too: 81.6 percent in the first group, vs. 65.3 percent in the second group
  • Also, median progression free survival was better in the group receiving lenalidomide maintenance vs no maintenance, 41.9 months in the first group vs. 21.6 months in the second group

Not surprisingly, they conclude that "Consolidation therapy with high-dose melphalan plus stem-cell transplantation, as compared with MPR, significantly prolonged progression-free and overall survival among patients with multiple myeloma who were 65 years of age or younger. Lenalidomide maintenance, as compared with no maintenance, significantly prolonged progression-free survival."

It is important to note that this study was funded by Celgene, the company that makes and sells both melphalan and lenalidomide.

Source: NEJM


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