A large, comparative, phase III HOVON clinical trial recently confirmed that upfront autologous stem cell transplantation (ASCT) should still be the treatment of choice in younger patients with newly diagnosed multiple myeloma (MM).

The findings of this trial clearly demonstrated that ASCT should remain the preferred treatment for younger patients with MM. The clinical trial evaluated a total of 1,266 patients less than 65 years of age with newly diagnosed MM between February 2011 and April 2014.

In the study, all patients underwent induction therapy with Velcade (bortezomib)–cyclophosphamide–dexamethasone chemotherapy and then were assigned to receive additional standard dose chemotherapy or high dose chemotherapy and ASCT and directly compared.

  • 4 more cycles of Velcade/melphalan/prednisone (VMP; n=512)


  • High-dose melphalan chemotherapy with single- or double-ASCT (n=754)

All patients received maintenance therapy with Revlimid (lenalidomide) until disease progression or intolerable side effects.

Currently, the median follow-up for the study is 23.9 months, and patients in the ASCT group have a significantly improved outcome. ASCT treated patients have a 24 percent lower risk of disease progression compared to chemotherapy. The study authors noted that data on overall survival is not yet mature, and there are no differences between treatment groups at the time of analysis. Future analyses will compare the overall survival, side effects, and quality of life associated with AHCT and novel agents.

Reference: Cavo M, Palumbo A, Zweegman S, et al. Upfront autologous stem cell transplantation (ASCT) versus novel agent-based therapy for multiple myeloma (MM): A randomized phase 3 study of the European Myeloma Network (EMN02/HO95 MM trial). Abstract #8000. Presented at the 2016 American Society of Clinical Oncology Annual Meeting, Chicago, IL, June 3, 2016.

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