Time Between Induction, HSCT Impacts Survival Outcomes in MM

By Patrick Daly - October 10, 2023

In research presented in Bone Marrow Transplantation, investigators examined whether the time interval from ending induction therapy to receiving an autologous hematopoietic stem cell transplant (AHSCT) impacted outcomes in patients with multiple myeloma (MM). Lead author, Charalampos Charalampous, MD, noted that the last cycle of induction therapy is typically completed two to four weeks before transplantation.

Based on a retrospective analysis of patients with newly diagnosed MM, Dr. Charalampous and colleagues concluded that a prolonged time to transplant (TTT) was associated with worse outcomes compared with a more rapid schedule. The effect of shortened TTT was “especially prevalent in patients with partial response at induction,” according to the study.

Researchers identified 1,055 patients diagnosed with MM from 2004 to 2018 who underwent AHSCT within a year of diagnosis. Patients were excluded if they had disease progression during induction therapy were excluded or if they underwent cytoxan pulsing, as that would artificially extend TTT. The study reviewed the duration and dosing of participants’ induction regimens, the date of final chemotherapy, and any biochemical response achieved before transplantation.

The patients’ median TTT was 33 days (interquartile range, 27-42), and researchers found patients with less than 33 days of TTT showed significantly longer progression-free survival (PFS) at 35.6 months versus 32.1 months in patients with more than 33 days of TTT (P<.03); however, there was not a significant difference in overall survival.

Patients with a TTT less than 27 days, the first quartile, had significantly longer PFS versus those with a TTT more than 42 days, the fourth quartile (36.7 months vs 30.9 months; P<.01). Additionally, patients with partial or worse responses before undergoing AHSCT in the first quartile had a PFS of 37.7 months compared with 28.7 months in similar patients in the fourth quartile (P<.04).

“We showed that a prolonged TTT is associated with inferior outcomes compared to tighter chemotherapy schedules,” they wrote. “This finding was especially prevalent in patients with partial response at induction.”


Charalampous C, Goel U, Gertz M, et al. Impact of the time interval between end of induction and autologous hematopoietic transplantation in newly diagnosed patients with multiple myeloma. Bone Marrow Transplant. 2023;58(1):46-53. doi:10.1038/s41409-022-01835-y

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