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Adding an early autologous stem cell transplant to modern three-drug therapy delayed relapse in newly diagnosed myeloma, though overall survival was similar because patients in the drug-only arm could have a transplant later.
Phase 3 trial of 700 adults up to 65 with newly diagnosed multiple myeloma randomised to lenalidomide, bortezomib and dexamethasone (RVD) alone (eight cycles) or RVD with high-dose melphalan and autologous transplant, both followed by a year of lenalidomide maintenance.
Median progression-free survival was 50 months with transplant against 36 months without; complete response 59 versus 48 percent. Four-year overall survival was 81 versus 82 percent, with most drug-only patients receiving transplant at relapse.
Upfront transplant remains standard for fit patients because it lengthens the first remission, but deferring it to first relapse is a reasonable choice for some, particularly with deeper modern induction.
Shares Newly diagnosed multiple myeloma, transplant-eligible, Bortezomib, Lenalidomide, Dexamethasone.
Shares IFM 2009, Newly diagnosed multiple myeloma, transplant-eligible.
Shares Newly diagnosed multiple myeloma, transplant-eligible, Bortezomib, Lenalidomide, Dexamethasone.
Shares Bortezomib, Lenalidomide, Dexamethasone.
Shares Newly diagnosed multiple myeloma, transplant-eligible, Bortezomib, Dexamethasone.
Shares Bortezomib, Lenalidomide, Dexamethasone.
Shares Bortezomib, Lenalidomide, Dexamethasone.
Shares Bortezomib, Lenalidomide, Dexamethasone.
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