Conditioning Regimens Prior to Autologous Transplantation for Multiple Myeloma

Researchers compared conditioning regimens to determine whether outcomes for patients with multiple myeloma (MM) undergoing autologous stem cell transplantation could be improved. Results were reported at the 2021 American Society of Hematology (ASH) Annual Meeting by Scott R. Solomon, MD, of Northside Hospital Cancer Institute in Atlanta, Georgia, and colleagues.

This study was a prospective phase 2 clinical trial comparing a high-dose chemotherapy regimen of bendamustine, etoposide, cytarabine, and melphalan (BeEAM) with a conventional conditioning approach involving a single dose of melphalan at 200mg/m² (Mel200). The study included adults up to 70 years of age who had MM and adequate organ function, who were within 9 months of the start of induction therapy, and who had no signs of relapse or progression. The purpose of the study was to evaluate the safety and efficacy of BeEAM.

There were 65 patients in the BeEAM group and 107 patients in the Mel200 group. Baseline characteristics and treatment characteristics involving induction therapy and use of posttransplant maintenance therapy were similar between the BeEAM and Mel200 groups.

The median time to neutrophil recovery was 11 days, and the median time to platelet recovery was 17 days. These each were 1 day faster than was seen with the Mel200 group for these outcomes.

Day 100 response rates, however, were similar between groups. There was a very good partial response or better in 89% of patients receiving BeEAM, and in 83% of patients receiving Mel200. The rate of complete response or better was 40% with BeEAM and 46% with Mel200, a difference that was not statistically significant (P =.32). Progression-free survival (PFS) and overall survival (OS) rates were also similar between treatment groups, including in analyses considering risk status.

Reportedly, the BeEAM group did not have any grade 3 or 4 nonhematologic adverse events (AEs). Additionally, there were no renal or hepatic AEs of grade 3 or higher and no nonrelapse deaths reported during the first year after transplant. Grade 3 stomatitis/esophagitis was reported in 28%, with grade 3 nausea/vomiting and diarrhea each reported in 25% of patients in the BeEAM group.

The researchers determined that BeEAM was safe and effective for conditioning. “Prior to autologous transplant for patients with multiple myeloma up to 70 years of age, BeEAM resulted in faster neutrophil and platelet engraftment when compared to Mel200,” Dr Solomon said in presentation accompanying the research team’s poster.

However, Dr Solomon and colleagues concluded that the BeEAM regimen seemed to not provide a significant benefit over Mel200 in response quality, PFS, or OS for either standard-risk or high-risk patients with MM.

Disclosure: One study author declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.

Reference

Solomon SR, Solh M, Brown S, et al. High-dose bendamustine, etoposide, cytarabine and melphalan (BeEAM) conditioning prior to autologous transplantation for patients with multiple myeloma: results of a prospective phase II trial. Presented at ASH 2021; December 11-14, 2021. Abstract 1831.

This article originally appeared on Hematology Advisor