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Hematol Oncol. 2018 Apr;36(2):436-444. doi: 10.1002/hon.2490. Epub 2018 Jan 24.

Prolonged survival after second autologous transplantation and lenalidomide maintenance for salvage treatment of myeloma patients at first relapse after prior autograft.

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Department of Medical Oncology, Inselspital, University Hospital of Bern, Bern, Switzerland.
Department of Hematology, Inselspital, University Hospital of Bern, Bern, Switzerland.
Department of Oncology, Kantonsspital Fribourg, Fribourg, Switzerland.
Department of Oncology, Kantonsspital Solothurn, Solothurn, Switzerland.
Department of Oncology, Kantonsspital Lucerne, Lucerne, Switzerland.


Autologous stem cell transplantation (ASCT) as part of the primary therapy in multiple myeloma (MM) is standard practice. In contrast, the role of a second ASCT (ASCT2) and subsequent lenalidomide maintenance for relapsed disease remains unclear. In this study, we analysed 86 consecutive MM patients with a first relapse after prior ASCT receiving either a second ASCT or conventional chemotherapy. After a median follow-up of 37.7 months since first relapse, 54 (62.8%) patients were still alive and 29 (33.7%) without progression. Sixty-one (71.0%) patients received ASCT2 and had better progression-free survival (PFS) (30.2 versus 13.0 mo; P = .0262) and overall survival (OS) rates (129.6 versus 33.5 mo; P = .0003) compared with 25 (29.0%) patients with conventional treatment. Patients relapsing later than 12 months after ASCT1 benefitted from a second ASCT with better PFS2 (P = .0179) and OS2 (P = .0009). Finally, lenalidomide maintenance after ASCT2 was associated with longer PFS (41.0 vs 21.6 mo; P = .0034) and better OS (not yet reached vs 129.6 mo; P = .0434) compared with patients without maintenance. Our data suggest that a second ASCT and lenalidomide maintenance given at first relapse in MM after prior ASCT are associated with better survival rates.


autologous; chemotherapy; high-dose; lenalidomide; maintenance; myeloma; relapse; salvage; stem cell; survival; transplant

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