BACKGROUND: Evidence bearing on the efficacy of tandem autologous hematopoietic transplant (AHCT) vs a single AHCT in patients with multiple myeloma (MM) is conflicting. We performed a systematic review and meta-analysis to synthesize the existing evidence related to the effectiveness of tandem vs single AHCT in patients with MM. METHODS: We searched Medline, conference proceedings, and bibliographies of retrieved articles and contacted experts in the field to identify randomized controlled trials (RCTs) reported in any language that compared tandem with single AHCT in patients with MM through March 31, 2008. Endpoints were overall survival (OS), event-free survival (EFS), response rate, and treatment-related mortality (TRM). Data were pooled under a random-effects model. RESULTS: Six RCTs enrolling 1803 patients met the inclusion criteria. Patients treated with tandem AHCT did not have better OS (hazard ratio [HR] for mortality for patients treated with tandem transplant vs single transplant = 0.94; 95% confidence interval [CI] = 0.77 to 1.14) or EFS (HR = 0.86; 95% CI = 0.70 to 1.05). Response rate was statistically significantly better with tandem AHCT (risk ratio = 0.79, 95% CI = 0.67 to 0.93), but with a statistically significant increase in TRM (risk ratio = 1.71, 95% CI = 1.05 to 2.79). There was statistically significant heterogeneity among RCTs for OS and EFS. CONCLUSION: In previously untreated MM patients, use of tandem AHCT did not result in improved OS or EFS. We conclude that tandem AHCT is associated with improved response rates but at risk of clinically significant increase in TRM.
BACKGROUND: Evidence bearing on the efficacy of tandem autologous hematopoietic transplant (AHCT) vs a single AHCT in patients with multiple myeloma (MM) is conflicting. We performed a systematic review and meta-analysis to synthesize the existing evidence related to the effectiveness of tandem vs single AHCT in patients with MM. METHODS: We searched Medline, conference proceedings, and bibliographies of retrieved articles and contacted experts in the field to identify randomized controlled trials (RCTs) reported in any language that compared tandem with single AHCT in patients with MM through March 31, 2008. Endpoints were overall survival (OS), event-free survival (EFS), response rate, and treatment-related mortality (TRM). Data were pooled under a random-effects model. RESULTS: Six RCTs enrolling 1803 patients met the inclusion criteria. Patients treated with tandem AHCT did not have better OS (hazard ratio [HR] for mortality for patients treated with tandem transplant vs single transplant = 0.94; 95% confidence interval [CI] = 0.77 to 1.14) or EFS (HR = 0.86; 95% CI = 0.70 to 1.05). Response rate was statistically significantly better with tandem AHCT (risk ratio = 0.79, 95% CI = 0.67 to 0.93), but with a statistically significant increase in TRM (risk ratio = 1.71, 95% CI = 1.05 to 2.79). There was statistically significant heterogeneity among RCTs for OS and EFS. CONCLUSION: In previously untreated MMpatients, use of tandem AHCT did not result in improved OS or EFS. We conclude that tandem AHCT is associated with improved response rates but at risk of clinically significant increase in TRM.
Authors: Sergio Giralt; David H Vesole; George Somlo; Amrita Krishnan; Edward Stadtmauer; Philip Mccarthy; Marcelo C Pasquini Journal: J Natl Cancer Inst Date: 2009-06-17 Impact factor: 13.506
Authors: H Ludwig; J S Miguel; M A Dimopoulos; A Palumbo; R Garcia Sanz; R Powles; S Lentzsch; W Ming Chen; J Hou; A Jurczyszyn; K Romeril; R Hajek; E Terpos; K Shimizu; D Joshua; V Hungria; A Rodriguez Morales; D Ben-Yehuda; P Sondergeld; E Zamagni; B Durie Journal: Leukemia Date: 2013-10-09 Impact factor: 11.528
Authors: Taiga Nishihori; Todd J Alekshun; Kenneth Shain; Daniel M Sullivan; Rachid Baz; Lia Perez; Joseph Pidala; Mohamed A Kharfan-Dabaja; Jose L Ochoa-Bayona; Hugo F Fernandez; Danielle N Yarde; Vasco Oliveira; William Fulp; Gang Han; Jongphil Kim; Dung-Tsa Chen; Jyoti Raychaudhuri; William Dalton; Claudio Anasetti; Melissa Alsina Journal: Br J Haematol Date: 2012-03-26 Impact factor: 6.998
Authors: Michele Cavo; S Vincent Rajkumar; Antonio Palumbo; Philippe Moreau; Robert Orlowski; Joan Bladé; Orhan Sezer; Heinz Ludwig; Meletios A Dimopoulos; Michel Attal; Pieter Sonneveld; Mario Boccadoro; Kenneth C Anderson; Paul G Richardson; William Bensinger; Hans E Johnsen; Nicolaus Kroeger; Gösta Gahrton; P Leif Bergsagel; David H Vesole; Hermann Einsele; Sundar Jagannath; Ruben Niesvizky; Brian G M Durie; Jesus San Miguel; Sagar Lonial Journal: Blood Date: 2011-03-29 Impact factor: 22.113