DR MIKHAEL: This late-breaking abstract may well have actually been the most talked about abstract at ASH with respect to myeloma this year, and I think rightly so. I think we have come to appreciate that transplant still has a critical role in eligible patients in myeloma. But what we didn’t fully know or are trying to learn is, is 1 transplant enough or should we do two? Is 1 transplant then maintenance enough? Or should we do more consolidation after the first transplant?

And we have some studies that seem to have indicated that in certain patients, tandem transplant works. In other patients, consolidation works. In other patients, you may as well just go to maintenance. And that’s what this study looked at. It was a randomized study of people getting either 2 transplants then maintenance, transplant, consolidation, then maintenance or just transplant and maintenance.

And the bottom line is, all 3 groups fared very similarly. And I think it’ll influence our myeloma community to do fewer second transplants and, quite likely, less consolidation that, with good up-front therapy, a single transplant and lenalidomide maintenance is really the standard of care.

Now, it does differ a little bit from some European studies, but probably because in those European studies they didn’t have the bortezomib/lenalidomide/dex up front, like most patients received in this study, such that they still had a greater burden of disease. And in those European studies, it may have been beneficial to have a second transplant or consolidation.

DR LOVE: Mm-hmm. Right now in your own practice, if you think back, let’s say, over the past year, how often, if at all, do you use either tandem transplant or some form of consolidation?

DR MIKHAEL: Very rarely, Neil. We may occasionally do some consolidation after a single transplant if there’s still a significant burden of disease where people, for example, haven’t achieved a VGPR before planning to go on to just lenalidomide maintenance.

But now with up-front bortezomib/lenalidomide/dex plus a single transplant, the overwhelming majority of patients are in a VGPR, and we take them just to lenalidomide maintenance. We almost never do tandems anymore. I mean, there may be some evidence in the very high-risk patient to consider that. But what we do is, we collect enough cells for 2 transplants and save them for later to potentially use as a salvage transplant.

Up-front management of newly diagnosed multiple myeloma (MM)

Management of relapsed/refractory MM

Smoldering myeloma and primary amyloidosis

Non-Hodgkin lymphomas

Hodgkin lymphoma

Chronic lymphocytic leukemia

Acute myeloid leukemia (AML)

Myelodysplastic syndromes (MDS)

Myelofibrosis