title: Autologous stem cell transplantation versus novel drugs or conventional chemotherapy for patients with relapsed multiple myeloma after previous ASCT.
abstract: High-dose therapy (HDT) followed by autologous stem cell transplantation (ASCT) is the most common first-line treatment for patients with multiple myeloma (MM) under 65 years of age. A second ASCT at first relapse is frequently used but is challenged by the use of novel drugs. We retrospectively studied the outcome of second-line treatment in MM patients from the Nordic countries with relapse after first-line HDT and ASCT. Patients that underwent a second ASCT (n=111) were compared with patients re-treated with conventional cytotoxic drugs only (n=91) or with regimens including novel drugs (proteasome inhibitors and/or immunomodulatory drugs) (n=362) without a second ASCT. For patients receiving a second ASCT median overall survival was 4.0 years compared with 3.3 years (P<0.001) for the group treated with novel drugs and 2.5 years (P<0.001) for those receiving conventional cytotoxic drugs only. A second ASCT also resulted in a significantly longer second time to progression and a significantly longer time to next treatment. We conclude that, irrespective of the addition of novel drugs, MM patients in first relapse after ASCT still appear to benefit from a second ASCT. A second ASCT should be considered for all physically fit patients.
authors: Department of Medicine, Karolinska Institutet, Center for Hematology, Karolinska University Hospital Huddinge, Stockholm, Sweden.
authors: M
authors: M
authors: Grövdal
authors: Department of Medicine, Karolinska Institutet, Center for Hematology, Karolinska University Hospital Huddinge, Stockholm, Sweden.
authors: H
authors: H
authors: Nahi
authors: Department of Medicine, Karolinska Institutet, Center for Hematology, Karolinska University Hospital Huddinge, Stockholm, Sweden.
authors: G
authors: G
authors: Gahrton
authors: Department of Medicine, Karolinska Institutet, Center for Hematology, Karolinska University Hospital Huddinge, Stockholm, Sweden.
authors: J
authors: J
authors: Liwing
authors: 1] Saint Olavs Hospital, Norwegian University of Science and Technology, Trondheim, Norway [2] KG Jebsen Center for Myeloma Research, IKM, Norwegian University of Science and Technology, Trondheim, Norway.
authors: A
authors: A
authors: Waage
authors: Department of Hematology, Odense University Hospital, Odense, Denmark.
authors: N
authors: N
authors: Abildgaard
authors: Department of Hematology, Esbjerg Hospital, Esbjerg, Denmark.
authors: P T
authors: PT
authors: Pedersen
authors: 1] Saint Olavs Hospital, Norwegian University of Science and Technology, Trondheim, Norway [2] KG Jebsen Center for Myeloma Research, IKM, Norwegian University of Science and Technology, Trondheim, Norway.
authors: J
authors: J
authors: Hammerstrøm
authors: Department of Hematology, Turku University Hospital, Turku University, Turku, Finland.
authors: A
authors: A
authors: Laaksonen
authors: Department of Hematology, Kainuu Central Hospital, Kajaani, Finland.
authors: P
authors: P
authors: Bazia
authors: Department of Hematology, Tampere University Hospital, Tampere, Finland.
authors: V
authors: V
authors: Terava
authors: Department of Hematology, Satakunta Central Hospital, Pori, Finland.
authors: H
authors: H
authors: Ollikainen
authors: Department of Hematology, Kuopio University Hospital, Kuopio, Finland.
authors: R
authors: R
authors: Silvennoinen
authors: Department of Hematology, Turku University Hospital, Turku University, Turku, Finland.
authors: M
authors: M
authors: Putkonen
authors: Department of Hematology, Helsinki University Hospital Comprehensive Cancer Center, Helsinki, Finland.
authors: P
authors: P
authors: Anttila
authors: Department of Hematology, Helsinki University Hospital Comprehensive Cancer Center, Helsinki, Finland.
authors: K
authors: K
authors: Porkka
authors: Department of Hematology, Turku University Hospital, Turku University, Turku, Finland.
authors: K
authors: K
authors: Remes
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D064592:Autografts; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000628:therapy*; D033581:Stem Cell Transplantation