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Comparative Study
. 2025 Jan;14(1):e70573.
doi: 10.1002/cam4.70573.

Tandem Versus Single Autologous Stem Cell Transplantation for High-Risk Multiple Myeloma in the Era of Novel Agents: A Real-World Study of China

Xuelin Dou  1 , Juan Ren  2 , Jiangtao Li  3 , Xiaodan Liu  4 , Li Bao  5 , Yuan Chen  5 , Peng Zhao  6 , Yuping Zhong  7 , Nan Peng  1 , Lei Wen  1 , Leqing Cao  1 , Yang Liu  1 , Daoxing Deng  1 , Fengrong Wang  1 , Liru Wang  8 , Hui Liu  3 , Xiaojun Huang  1 , Xiaodong Mo  1 , Jin Lu  1
Affiliations
Comparative Study

Tandem Versus Single Autologous Stem Cell Transplantation for High-Risk Multiple Myeloma in the Era of Novel Agents: A Real-World Study of China

Xuelin Dou et al. Cancer Med. 2025 Jan.

Abstract

Background: This study compares the efficacy and safety of single autologous stem cell transplantation (ASCT) versus tandem ASCT for multiple myeloma (MM) patients in the era of novel agents.

Methods: A total of 112 high-risk MM patients were included (single ASCT, (n = 57) or tandem ASCT(n = 55) in this retrospective multicenter study. Responses and outcomes were evaluated.

Results: At 100 days after ASCT1 and ASCT2, 36 (63.2%) versus 45 (81.8%) patients achieved sCR/CR, 16 (28.1%) versus 7 (12.7%) patients achieved VGPR, and 5 (8.8%) versus 1 (1.8%) patient achieved PR, respectively, in the single and tandem ASCT cohorts. The 3-year cumulative incidence of non-relapse mortality and disease progression was 0% versus 7.3% (p = 0.083), and 45.8% versus 25.8% (p = 0.039), respectively, for the single and tandem ASCT cohort. The tandem ASCT cohort showed a trend of better 3-year probability of PFS (58.1% vs. 64.7%, p = 0.064) compared with the single ASCT cohort. In multivariate analysis, ultra high-risk and achieving<VGPR response after ASCT1 were associated with an inferior PFS. Ultra high-risk was also associated with an inferior OS.

Conclusions: Tandem ASCT demonstrated improved outcomes compared to single ASCT in high-risk MM patients receiving triplet or quadruplet induction and maintenance therapy. However, patients with ultra high-risk cytogenetics may require innovative therapeutic approaches, as tendem ASCT does not overcome their adverse prognosis.

Keywords: autologous stem cell transplant; multiple myeloma; tandem.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Inclusion of patients from multicenter in China.
FIGURE 2
FIGURE 2
The Sankey diagram shows the flow of responses prior to ASCT and post‐ASCT1 for the total cohort, as well as post‐ASCT2 for the tandem cohort.
FIGURE 3
FIGURE 3
The overall response rates (ORR) between post‐ASCT1 of single ASCT cohort and post‐ASCT2 of tandem ASCT cohort (data normalized to 100%). *The Chi‐Square test for trend indicated a significant difference in the ORR rate between the two groups.
FIGURE 4
FIGURE 4
Cumulative incidence of non‐relapse mortality and disease progression, kaplan–meier curve of progression‐free survival and overall survival for single and tandem ASCT cohorts.
See this image and copyright information in PMC

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