Efficacy and Safety of Tandem Autologous Stem Cell Transplantation in Multiple Myeloma: A Retrospective Single-Center Analysis in China

Background: The role of tandem autologous stem cell transplantation (ASCT) in multiple myeloma remains debatable, and data on tandem ASCT in China are limited. This study aimed to review the efficacy and safety of tandem ASCT in Chinese patients with myeloma.

Methods: We performed a retrospective analysis of 50 patients with newly diagnosed multiple myeloma (NDMM) who underwent tandem ASCT between November 2014 and January 2021 in our center.

Results: From the first transplant, the median progression-free survival (PFS) and overall survival (OS) in patients with NDMM were 52.4 months (95% confidence interval [CI]: 22.9-81.9) and not reached, respectively. There were no significant differences in PFS and OS based on sex, platelet count, hemoglobin, subtype, β2-microglobulin, renal function, ISS stage, R-ISS, cytogenetic risk, induction regimens, remission status pre-first transplant. Patients with initially elevated lactate dehydrogenase (LDH) levels or without maintenance therapy (MT) had worse PFS and OS. The LDH level was a predictor in univariate analysis but not in multivariate analysis for PFS (P = 0.775, HR 1.24, 95% CI 0.28-5.4) and OS (P = 0.112, HR 4.86, 95% CI 0.69-34.3). Multivariate analysis revealed that MT absence was an independent adverse factor for PFS (P = 0.003, hazard ratio [HR] 0.092, 95% CI 0.019-0.442) but not for OS. No transplant-related mortality was observed. Mucositis, engraftment syndrome, and infection were common but manageable complications. One patient developed acute lymphoblastic leukemia.

Conclusion: Upfront tandem ASCT could overcome the adverse prognosis of ISS stages and unfavorable cytogenetic risk and could be performed feasibly and safely in patients with myeloma.

No relevant conflicts of interest to declare.