Dr. Martin on Transplant and Maintenance for Patients With High-Risk Myeloma

Thomas G. Martin, MD, clinical professor of medicine, Adult Leukemia and Bone Marrow Transplantation Program, and associate director, Myeloma Program, University of California, San Francisco; co-leader, Hematopoietic Malignancies Program, Helen Diller Family Comprehensive Cancer Center, discusses transplant and maintenance for the treatment of patients with high-risk multiple myeloma.

There is no standard approach for patients with high-risk disease in terms of transplant and maintenance, explains Martin. The StaMINA trial was conducted in the United States and compared a single autologous stem cell transplant (ASCT) with a tandem ASCT. There was no difference in terms of benefit, notes Martin. A European trial called the EMN02 trial, looked at bortezomib (Velcade)-based induction with cyclophosphamide and dexamethasone. Patients who received induction followed by tandem ASCT did better than those who received induction followed by single transplant. The best results were seen in patients with high-risk disease, adds Martin.

Of note, says Martin, is that investigators in the European study did not use an immunomodulatory agent as initial induction therapy. In the United States, almost every patient gets immunotherapy and a proteasome inhibitor. Therefore, if a physician uses that regimen, patients will likely benefit from a single transplant. In terms of maintenance, a trial from the United Kingdom demonstrated benefit with lenalidomide (Revlimid) maintenance, even if the patient had high-risk disease.