Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

High-Dose Therapy+ASCT in Multiple Myeloma Studied

JAMA Oncol; ePub 2018 Jan 4; Dhakal, Szabo, et al

High-dose therapy with melphalan+autologous stem cell transplant (HDT/ASCT) resulted in better progression-free survival than standard dose therapy (SDT) in patients with multiple myeloma, according to a meta-analysis of 9 studies involving nearly 6,000 individuals. Investigators included studies comparing single HDT/ASCT with SDT using novel agents. They looked at progression-free and overall survival, complete response, and treatment-related mortality. Among the findings:

  • Patients receiving HDT/ASCT were 27% more likely to experience complete response than those receiving SDT.
  • HDT patients experienced better progression-free and overall survival.
  • Patients receiving tandem HDT/ASCT experienced the most favorable progression-free survival, followed by single HDT/ASCT with bortezomib, lenalidomide, and dexamethasone; and single HDT/ASCT alone.
  • No HDT/ASCT-based approach significantly impacted overall survival.
  • HDT/ASCT treatment-related mortality was minimal.


Dhakal B, Szabo A, Chhabra S, et al. Autologous transplantation for newly diagnosed multiple myeloma in the era of novel agent induction: A systematic review and meta-analysis. [Published online ahead of print January 4, 2018]. JAMA Oncol. doi:10.1001/jamaoncol.2017.4600.

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