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<p>Autologous hematopoietic stem cell transplantation has been shown to improve survival for patients with multiple myeloma. However, the optimal timing and depth of response which is needed before transplant is debatable.&#xa0;In this retrospective study, we analysed data of 166 patients with multiple myeloma who underwent their first autologous stem cell transplantation (ASCT) from 1st January 2002 to 31st December, 2018 at our centre. Our primary objective was to compare PFS between patients who were in partial response (PR) versus those in ≥ very good partial response (VGPR) prior to transplant. Our secondary objectives were to analyse the association of baseline factors and pre-transplant disease status with post-transplant response; and to study the relation of pre and post-transplant disease response with survival.&#xa0;Median age of entire cohort was 55 years with male predominance. Two-third of patients (63%) received bortezomib-based triplet regimens for induction, with a median number of 4 cycles prior to transplant. Median follow-up post-transplant was 46 months. Median PFS and OS of the entire cohort was 43 months and 79 months respectively. For patients in pre-transplant PR (n = 76) versus ≥ VGPR (n = 90), median PFS was 40 months and 47 months (p = 0.22), while median OS was 71 months and 83 months (p = 0.44), respectively. For patients in pretransplant PR, 86% achieved deepening of response i.e., ≥VGPR at day + 100 post-transplant. Attainment of ≥ VGPR after transplant (rather than pre-transplant) corelated with survival.&#xa0;Patients with pre-transplant PR have similar time to progression and overall survival, as patients with pre-transplant ≥ VGPR. Nearly 90% patients with pre-transplant PR achieve a VGPR or more at day + 100 post-ASCT, which is associated with survival benefit. Hence, switching to a salvage regimen or waiting for more time in anticipation of a deeper response prior to transplant is not essential.</p>

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Is it Necessary to Achieve a Very Good Partial Response Prior to Transplant? Comparison of Outcomes in Pre-Transplant Partial Response Versus Very Good Partial Response or Deeper

  • 期刊论文

  • 发表日期：

    2025年9月16日

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  • Sumeet Mirgh,
  • Jyotsna Kapoor,
  • Niharika Bhatia,
  • Reema Singh,
  • Vishvdeep Khushoo,
  • Ambar Garg,
  • Faran Naim,
  • Rohan Halder,
  • Narendra Agrawal,
  • Rayaz Ahmed,
  • Dinesh Bhurani

摘要

Autologous hematopoietic stem cell transplantation has been shown to improve survival for patients with multiple myeloma. However, the optimal timing and depth of response which is needed before transplant is debatable. In this retrospective study, we analysed data of 166 patients with multiple myeloma who underwent their first autologous stem cell transplantation (ASCT) from 1st January 2002 to 31st December, 2018 at our centre. Our primary objective was to compare PFS between patients who were in partial response (PR) versus those in ≥ very good partial response (VGPR) prior to transplant. Our secondary objectives were to analyse the association of baseline factors and pre-transplant disease status with post-transplant response; and to study the relation of pre and post-transplant disease response with survival. Median age of entire cohort was 55 years with male predominance. Two-third of patients (63%) received bortezomib-based triplet regimens for induction, with a median number of 4 cycles prior to transplant. Median follow-up post-transplant was 46 months. Median PFS and OS of the entire cohort was 43 months and 79 months respectively. For patients in pre-transplant PR (n = 76) versus ≥ VGPR (n = 90), median PFS was 40 months and 47 months (p = 0.22), while median OS was 71 months and 83 months (p = 0.44), respectively. For patients in pretransplant PR, 86% achieved deepening of response i.e., ≥VGPR at day + 100 post-transplant. Attainment of ≥ VGPR after transplant (rather than pre-transplant) corelated with survival. Patients with pre-transplant PR have similar time to progression and overall survival, as patients with pre-transplant ≥ VGPR. Nearly 90% patients with pre-transplant PR achieve a VGPR or more at day + 100 post-ASCT, which is associated with survival benefit. Hence, switching to a salvage regimen or waiting for more time in anticipation of a deeper response prior to transplant is not essential.