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Myeloma stem cell transplant11/9/2023 ![]() ![]() “It is now possible to achieve CR and MRD-negativity with chemotherapy alone in an increasing fraction of people. “Do we need transplant to get patients into CR or MRD-negativity?” Mark asked. Patients with a CR prior to ASCT did not achieve a longer overall survival, he noted. The landmark analysis based on response at two years after start of therapy found patients who upgraded their response with ASCT obtained a survival benefit. One study took a retrospective look at 758 consecutive patients at MD Anderson Cancer Center undergoing induction followed by ASCT within one year of diagnosis. “Do you need a transplant if you achieve CR with induction therapy?” he asked. ![]() The impact of response to induction to achieve CR is pre-transplant, not CR post-transplant,” he said. “Patients who achieve CR before transplant do not get this benefit after transplant. Stem cell transplant deepens treatment response, but he wondered whether a remission deeper than CR matters for transplant. Does remission deepen for CR? Patients who upgrade their response do better with transplant,” Mark said. The caveat is that this data is old very few patients (5-10 percent) achieve CR. He said he wondered why stem cell transplant is still recommended for patients in CR: “Stem cell transplant has an overall survival benefit. This leads to longer progression-free survival,” he said. “People in CR do better if they achieve MRD-negativity. Mark agreed there was no debate that MRD status is important because it can lead to a survival benefit. The role of maintenance is to deepen response,” Mark said.
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