Article open access publication

Autologous stem cell transplantation versus novel drugs or conventional chemotherapy for patients with relapsed multiple myeloma after previous ASCT

Bone Marrow Transplantation, Springer Nature, ISSN 0268-3369

Volume 50, 6, 2015

DOI:10.1038/bmt.2015.39, Dimensions: pub.1047262580, PMID: 25867654,


Grövdal, M * (1)
Nahi, H (1)
Liwing, J (1)
Waage, A (2)
Bazia, P (6)
Terava, V (7)
Anttila, P (10)
Porkka, K (10)
Remes, K (5)

* Corresponding author



  1. (1) Department of Medicine, Karolinska Institutet, Center for Hematology, Karolinska University Hospital Huddinge, Stockholm, Sweden
  2. (2) Norwegian University of Science and Technology, grid.5947.f
  3. (3) Odense University Hospital, grid.7143.1, Southern Denmark Region
  4. (4) Hospital of South West Jutland, grid.414576.5, Southern Denmark Region
  5. (5) Department of Hematology, Turku University Hospital, Turku University, Turku, Finland
  6. (6) Kainuun keskussairaala, grid.414820.b
  7. (7) Tampere University Hospital, grid.412330.7
  8. (8) Satakunta Central Hospital, grid.415303.0
  9. (9) Kuopio University Hospital, grid.410705.7
  10. (10) Department of Hematology, Helsinki University Hospital Comprehensive Cancer Center, Helsinki, Finland








High-dose therapy (HDT) followed by autologous stem cell transplantation (ASCT) is the most common first-line treatment for patients with multiple myeloma (MM) under 65 years of age. A second ASCT at first relapse is frequently used but is challenged by the use of novel drugs. We retrospectively studied the outcome of second-line treatment in MM patients from the Nordic countries with relapse after first-line HDT and ASCT. Patients that underwent a second ASCT (n=111) were compared with patients re-treated with conventional cytotoxic drugs only (n=91) or with regimens including novel drugs (proteasome inhibitors and/or immunomodulatory drugs) (n=362) without a second ASCT. For patients receiving a second ASCT median overall survival was 4.0 years compared with 3.3 years (P<0.001) for the group treated with novel drugs and 2.5 years (P<0.001) for those receiving conventional cytotoxic drugs only. A second ASCT also resulted in a significantly longer second time to progression and a significantly longer time to next treatment. We conclude that, irrespective of the addition of novel drugs, MM patients in first relapse after ASCT still appear to benefit from a second ASCT. A second ASCT should be considered for all physically fit patients.

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