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<p>Post-transplant maintenance therapy is a cornerstone of care for transplant-eligible patients with multiple myeloma (MM). While lenalidomide/bortezomib has been used as maintenance, clinical trials suggest that doublet maintenance may provide additional benefit, particularly in high-risk disease. Real-world evidence remains limited. We conducted a single-center retrospective analysis of patients with MM who underwent single autologous stem cell transplantation (ASCT) followed by maintenance therapy between 2015 and 2023. Doublet maintenance was defined as ≥2 agents and monotherapy maintenance as a single agent; dexamethasone was excluded from both definitions. The primary outcomes were event-free survival (EFS) and overall survival (OS). To mitigate treatment allocation bias, propensity score matching (PSM) was used to generate a pseudopopulation of monotherapy maintenance patients with characteristics comparable to those receiving doublet therapy. A total of 410 patients were included (doublet, <i>n</i> = 80; monotherapy, <i>n</i> = 330). The most common doublet and monotherapy regimens were bortezomib-lenalidomide (<i>n</i> = 46, 58%) and lenalidomide (<i>n</i> = 159, 48%), respectively. In the PSM analysis, doublet maintenance was associated with superior EFS (HR 0.58, <i>p</i> = 0.022; aHR 0.48, <i>p</i> = 0.007) and OS (HR 0.45, <i>p</i> = 0.022; aHR 0.47, <i>p</i> = 0.029). In this real-world analysis, doublet maintenance after ASCT was associated with superior EFS and OS, supporting broader consideration of this approach in MM.</p>

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Impact of doublet post-transplant maintenance on outcomes in multiple myeloma: A propensity score matching analysis

  • 期刊论文

  • 发表日期：

    2026年7月1日

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  • Ivan J. Huang,
  • Grace T. Baek,
  • Qian Vicky Wu,
  • Gui Zhen Chen,
  • Omar Marzouk,
  • Jonathan Cohen,
  • Mary Kwok,
  • Rahul Banerjee,
  • Kara Cicero,
  • Ryan Basom,
  • Leona Holmberg,
  • Ajay K. Gopal,
  • Yang Qiao,
  • Andrew J. Cowan,
  • Andrew J. Portuguese

摘要

Post-transplant maintenance therapy is a cornerstone of care for transplant-eligible patients with multiple myeloma (MM). While lenalidomide/bortezomib has been used as maintenance, clinical trials suggest that doublet maintenance may provide additional benefit, particularly in high-risk disease. Real-world evidence remains limited. We conducted a single-center retrospective analysis of patients with MM who underwent single autologous stem cell transplantation (ASCT) followed by maintenance therapy between 2015 and 2023. Doublet maintenance was defined as ≥2 agents and monotherapy maintenance as a single agent; dexamethasone was excluded from both definitions. The primary outcomes were event-free survival (EFS) and overall survival (OS). To mitigate treatment allocation bias, propensity score matching (PSM) was used to generate a pseudopopulation of monotherapy maintenance patients with characteristics comparable to those receiving doublet therapy. A total of 410 patients were included (doublet, n = 80; monotherapy, n = 330). The most common doublet and monotherapy regimens were bortezomib-lenalidomide (n = 46, 58%) and lenalidomide (n = 159, 48%), respectively. In the PSM analysis, doublet maintenance was associated with superior EFS (HR 0.58, p = 0.022; aHR 0.48, p = 0.007) and OS (HR 0.45, p = 0.022; aHR 0.47, p = 0.029). In this real-world analysis, doublet maintenance after ASCT was associated with superior EFS and OS, supporting broader consideration of this approach in MM.