P923: TANDEM AUTOLOGOUS STEM CELL TRANSPLANTATIONS STILL BENEFIT FOR MYELOMA PATIENTS: A POOLING META-ANALYSIS

Abstract

Background: Although high-dose therapy and autologous stem cell transplant combined with novel agents continues to be the hallmark of first-line treatment in newly diagnosed transplant-eligible multiple myeloma patients, disease progression remains an issue. To deepen the treatment response and prolong disease free survival, tandem autologous stem cell transplant is one of treatment choice. Compared to toxicity of sub-sequent pharmacotherapy or allogeneic transplant, tandem ASCT is well-tolerated. However, the efficacy of tandem ASCT is not fully defined yet. Thus, we aimed to assess effectiveness of tandem ASCT. Aims: To evaluate the true effect of tandem autologous/autologous stem cell transplantation for myeloma patients in current era. Methods: Eligible randomized controlled trials published before Dec 2021 were retrieved from databases. Myeloma patients received tandem autologous stem cell transplantation was included. Systematic review and pairwise meta-analysis were performed. We calculated the hazard ratio (HR) with 95% confidence intervals (CIs). Results: Ten articles, involving 3,123 patients, met the selection criteria. All studies demonstrated acceptable quality. The mean age was 58.2 year-old with mean 36.2% high risk cytogenetics feature. Eight trials were international multi-centers phase III RCTs. Tandem autologous stem cell transplantation compared to single ASCT was associated with a significantly superior progression free survival (random-effect HR 0.89; 95% CI 0.82-0.97; I2 = 0.0%), but no significance difference regard to overall survival (random-effect HR 0.98; 95% CI 0.94–1.03; I2 = 0%). For high risk myeloma subgroup, 4 trials compared tandem ASCT versus lenalidomide, tandem ASCT demonstrated superior progression free survival (random-effect HR 0.87; 95% CI 0.82–0.91; I2 = 0%) Image:Summary/Conclusion: In conclusion, tandem ASCT are still to be considered as an acceptable treatment options in general myeloma patients. High-risk cytogenetics is frequently observed in newly diagnosed myeloma with worsens outcome after single autologous, whereas a tandem autologous transplant strategy may overcome onset poor prognosis.