Dr Siegel on Real-World Outcomes With Tandem Transplant in Newly Diagnosed Myeloma

David Samuel Dicapua Siegel, MD, chief, Division of Multiple Myeloma, John Theurer Cancer Center, Hackensack University Medical Center, discusses real-world outcomes with tandem autologous stem cell transplantation in patients with newly diagnosed multiple myeloma, as presented by his colleague Harsh Parmar, MD, also of Hackensack University Medical Center, at the 2024 ASCO Annual Meeting.

Although stem cell transplant followed by maintenance therapy is the standard of care for transplant-eligible patients with newly diagnosed multiple myeloma, a minority of patients in this population undergo transplantation, Siegel begins. One alternative approach is tandem transplantation, which has demonstrated progression-free survival (PFS) and overall survival (OS) benefit, particularly for patients with high-risk cytogenetic abnormalities. However, this modality remains underutilized in clinical practice, Sigel notes.

At the 2024 Meeting, Parmar presented data from a multi-center, retrospective, observational study comparing the benefits of tandem transplant vs single stem cell transplant (SCT) followed by maintenance therapy. The study demonstrated significant improvements in unadjusted time to next treatment and OS for patients who underwent tandem transplant, despite a higher incidence of high-risk cytogenetics compared with patients who underwent single SCT. Propensity score analysis demonstrated a similar effect, with decreased hazard ratios for tandem transplantation vs SCT. Achieving OS as a primary outcome in a multiple myeloma randomized controlled trials is extremely challenging, as it often requires data collection over decades, Siegel notes.

Overall, these real-world data reveal a key departure from the current standard, highlighting that high-risk patients—those who need the greatest strides in treatment—benefit from tandem transplants, Sigel states. Moreover, the data suggest that patients with multiple myeloma generally will not experience OS benefit from maintenance lenalidomide (Revlimid), he adds. This insight could serve as a foundation for changing current practices, though inertia must be overcome to adopt tandem transplantation more broadly in clinical settings, Siegel concludes.