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The impact of re-induction prior to salvage autologous stem cell transplantation in multiple myeloma


Autologous stem cell transplantation (ASCT) is an integral component of the therapeutic arsenal in multiple myeloma. Given that overall survival (OS) is comparable between patients receiving up-front or delayed ASCT, some opt to collect stem cells and postpone transplant until the time of disease progression (i.e., salvage ASCT). It is unknown if induction should be repeated prior to salvage ASCT, or if patients should proceed directly. We identified 234 patients who underwent salvage ASCT at our institution: 188 (80%) were re-induced, whereas 46 (20%) proceeded directly without re-induction. There was no significant difference in time to next therapy (TNT) or OS from Day 0 between the two groups. Patients who were re-induced had a nonsignificant trend towards a higher rate of complete response post-ASCT (45 vs. 33%, p = .12). In multivariate models, re-induction did not affect TNT/OS. In the subgroup of 188 patients who were re-induced, patients with relapsed/refractory disease at the time of ASCT had significantly shorter TNT/OS compared to patients with deeper pre-ASCT responses. In summary, there was no survival difference for patients who were re-induced before salvage ASCT. However, many factors affect the decision to re-induce, and prospective studies would be required to discern its role definitively.

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Parts of these data were presented on Poster 4613 at the American Society of Hematology Annual Meeting in San Diego, California on 03 December 2018.


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We would like to acknowledge the patients and their families. KM was supported by CTSA Grant Number TL1TR002380 from the National Center for Advancing Translational Sciences (NCATS).

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Conflict of interest

SK has obtained research support for clinical trials from Celgene, Millennium, Novartis, Janssen, and Sanofi. AD has received research support for clinical trials from Pfizer, Jannsen, Millennium, Alnylam, and Celgene. MAG has received research support from ISIS and Prothena, and honoraria from Celgene, Millennium Pharmaceuticals, and Novartis. The remaining authors declare that they have no conflict of interest.

Correspondence to Shaji K. Kumar.

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