Autologous transplant vs oral chemotherapy and lenalidomide in newly diagnosed young myeloma patients: A pooled analysis

F. Gay, S. Oliva, M. T. Petrucci, V. Montefusco, C. Conticello, P. Musto, L. Catalano, A. Evangelista, S. Spada, P. Campbell, R. Ria, M. Salvini, M. Offidani, A. M. Carella, P. Omedé, A. M. Liberati, R. Troia, A. M. Cafro, A. Malfitano, A. P. FalconeT. Caravita, F. Patriarca, A. Nagler, A. Spencer, R. Hajek, A. Palumbo, M. Boccadoro

Research output: Contribution to journalArticlepeer-review


In newly diagnosed myeloma patients, upfront autologous transplant (ASCT) prolongs progression-free survival 1 (PFS1) compared with chemotherapy plus lenalidomide (CC+R). Salvage ASCT at first relapse may still effectively rescue patients who did not receive upfront ASCT. To evaluate the long-term benefit of upfront ASCT vs CC+R and the impact of salvage ASCT in patients who received upfront CC+R, we conducted a pooled analysis of 2 phase III trials (RV-MM-209 and EMN-441). Primary endpoints were PFS1, progression-free survival 2 (PFS2), overall survival (OS). A total of 268 patients were randomized to 2 courses of melphalan 200 mg/m 2 and ASCT (MEL200-ASCT) and 261 to CC+R. Median follow-up was 46 months. MEL200-ASCT significantly improved PFS1 (median: 42 vs 24 months, HR 0.53; P<0.001), PFS2 (4 years: 71 vs 54%, HR 0.53, P<0.001) and OS (4 years: 84 vs 70%, HR 0.51, P<0.001) compared with CC+R. The advantage was noticed in good and bad prognosis patients. Only 53% of patients relapsing from CC+R received ASCT at first relapse. Upfront ASCT significantly reduced the risk of death (HR 0.51; P=0.007) in comparison with salvage ASCT. In conclusion, these data confirm the role of upfront ASCT as the standard approach for all young myeloma patients.

Original languageEnglish
Pages (from-to)1727-1734
Number of pages8
Issue number8
StatePublished - 1 Aug 2017
Externally publishedYes


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