Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • News & Views
  • Published:

Haematological cancer

A critical appraisal of the ATLAS trial of maintenance therapy for multiple myeloma: end points, censoring and equipoise

A recent report from the ATLAS trial comparing different maintenance strategies following haematopoeitic stem cell transplantation for multiple myeloma provides an opportunity to explore various themes of critical appraisal, including end points, the equipoise of trial design, and the part censoring can play in the validity of results.

This is a preview of subscription content, access via your institution

Access options

Buy this article

Prices may be subject to local taxes which are calculated during checkout

Fig. 1: Reverse Kaplan–Meier analysis of censoring imbalances in the ATLAS trial.

References

  1. Rajkumar, S. V. Multiple myeloma: 2022 update on diagnosis, risk stratification, and management. Am. J. Hematol. 97, 1086–1107 (2022).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. McCarthy, P. L. et al. Lenalidomide maintenance after autologous stem-cell transplantation in newly diagnosed multiple myeloma: a meta-analysis. J. Clin. Oncol. 35, 3279–3289 (2017).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Freidlin, B., Little, R. F. & Korn, E. L. Design issues in randomized clinical trials of maintenance therapies. J. Natl. Cancer Inst. 107, djv225 (2015).

    Article  PubMed  PubMed Central  Google Scholar 

  4. Dytfeld, D. et al. Carfilzomib, lenalidomide, and dexamethasone or lenalidomide alone as maintenance therapy after autologous stem-cell transplantation in patients with multiple myeloma (ATLAS): interim analysis of a randomised, open-label, phase 3 trial. Lancet Oncol. 24, 139–150 (2023).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Freedman, B. Equipoise and the ethics of clinical research. N. Engl. J. Med. 317, 141–145 (1987).

    Article  CAS  PubMed  Google Scholar 

  6. Gilboa, S. et al. Informative censoring of surrogate end-point data in phase 3 oncology trials. Eur. J. Cancer 153, 190–202 (2021).

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

The authors acknowledge R. Mutai for his assistance with the censoring analysis discussed in this article.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Ghulam Rehman Mohyuddin.

Ethics declarations

Competing interests

T.M. reports receiving personal fees from Purple Biotech, outside the submitted work. G.R.M. declares no competing interests

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Mohyuddin, G.R., Meirson, T. A critical appraisal of the ATLAS trial of maintenance therapy for multiple myeloma: end points, censoring and equipoise. Nat Rev Clin Oncol 20, 735–736 (2023). https://doi.org/10.1038/s41571-023-00801-x

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41571-023-00801-x

Search

Quick links

Nature Briefing

Sign up for the Nature Briefing newsletter — what matters in science, free to your inbox daily.

Get the most important science stories of the day, free in your inbox. Sign up for Nature Briefing