Dr. Stewart on the Role of Transplant in Multiple Myeloma

Keith Stewart, MB, CHB, professor of medicine, consultant, Division of Hematology/Oncology, Department of Internal Medicine, Mayo Clinic, discusses the role of transplant in patients with multiple myeloma.

Recent clinical trials continue to support the use of transplant over the latest novel therapies. The combination of continuous bortezomib (Velcade), lenalidomide (Revlimid), and dexamethasone was compared with the same drugs followed by transplant and some consolidation. Patients who received a transplant had a significant improvement in progression-free survival. No overall survival data were reported due to the short follow-up.

That study was replicated and confirmed by a European study, which suggested that double transplant may be more beneficial than single transplant. That has yet to be confirmed in the United States. The StaMINA clinical trial looked at single and tandem transplant and consolidation chemotherapy in the United States. That study failed to confirm any benefit with a second transplant. In the United States, a single transplant remains the gold standard for patients who are able to undergo that operation, says Stewart.