The following is a summary of “Autologous followed by allogeneic versus tandem-autologous transplantation in high-risk, newly diagnosed multiple myeloma: a systematic review and meta-analysis,” published in the October 2023 issue of Hematology by Wei et al.
Despite advances in treatment, high-risk multiple myeloma (HRMM) has a poor prognosis, and the role of allogeneic stem cell transplantation (auto-allo-SCT) in HRMM is controversial. Researchers started a retrospective study to compare the efficacy and safety of auto-allo-SCT and tandem-auto-SCT in patients with HRMM.
They searched Embase, Cochrane Library, and PubMed databases (March 2023). Prospective or retrospective studies that compared the outcomes of auto-allo-SCT and tandem-auto-SCT were included. Hazard ratios (HRs) and 95% CIs for time-to-event results, along with odds ratios (ORs) and 95%CIs for dichotomous outcomes, were combined using random-effects models.
The results showed 3 studies encompassing 491 patients. Auto-allo-SCT showed potential improvements in progression-free survival (PFS) (with an HR [95%CI] of 0.71 [0.51–1.00]), complete response (CR) (with an OR [95%CI] of 3.16 [1.67–5.99]), and reduced relapse/progression rates (47% vs. 55%) when compared to tandem-auto-SCT. However, there was no significant enhancement in overall survival (OS). Auto-allo-SCT patients, unlike tandem-auto-SCT, faced increased risks of transplant-related mortality (TRM) (11.9% vs. 4.1%) and non-relapse mortality (NRM) (12.3% vs. 3.1%).
Investigators concluded that auto-allo-SCT shows improved PFS and CR but not OS in HRMM patients and has higher TRM and NRM risks, so it should be considered investigational.