The Efficacy and Safety of Tandem Transplant Versus Single Stem Cell Transplant for Multiple Myeloma Patients: A Systematic Review and Meta-Analysis

Yu-Han Chen; Lindsay Fogel; Andrea Yue-En Sun; Chieh Yang; Rushin Patel; Wei-Cheng Chang; Po-Huang Chen; Hong-Jie Jhou; Yeu-Chin Chen; Ming-Shen Dai; Cho-Hao Lee

doi:10.3390/diagnostics14101030

The Efficacy and Safety of Tandem Transplant Versus Single Stem Cell Transplant for Multiple Myeloma Patients: A Systematic Review and Meta-Analysis

Diagnostics (Basel). 2024 May 16;14(10):1030. doi: 10.3390/diagnostics14101030.

Authors

Yu-Han Chen¹, Lindsay Fogel², Andrea Yue-En Sun³, Chieh Yang⁴, Rushin Patel⁵, Wei-Cheng Chang⁶, Po-Huang Chen⁷, Hong-Jie Jhou⁸, Yeu-Chin Chen⁹, Ming-Shen Dai⁹, Cho-Hao Lee⁹

Affiliations

¹ Department of Internal Medicine, Englewood Hospital and Medical Center, Englewood, NJ 07631, USA.
² Hackensack Meridian School of Medicine, Nutley, NJ 07110, USA.
³ College of Medicine, National Yang Ming Chiao Tung University, Taipei 112, Taiwan.
⁴ Department of Internal Medicine, School of Medicine, University of California Riverside, Riverside, CA 92521, USA.
⁵ Department of Internal Medicine, Community Hospital of San Bernardino, San Bernardino, CA 92411, USA.
⁶ Department of Ophthalmology, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan 330, Taiwan.
⁷ Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan.
⁸ Department of Neurology, Changhua Christian Hospital, Changhua 500, Taiwan.
⁹ Division of Hematology and Oncology Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan.

Abstract

While high-dose therapy and autologous stem cell transplant (ASCT) remain integral to the primary treatment of newly diagnosed transplant-elble multiple myeloma (MM) patients, the challenge of disease progression persists. The primary objective of this meta-analysis is to evaluate the efficacy and safety of tandem ASCT compared to single ASCT. We conducted a systematic review and meta-analysis of randomized controlled trials and observational studies comparing tandem ASCT with single ASCT in patients with newly diagnosed MM. We searched PubMed, EMBASE, Cochrane Library, and Clinical Trials databases for studies published up to January 2024. The primary outcomes were progression-free survival (PFS), overall survival (OS), overall response rate (ORR), complete response rate (CRR), and treatment-related mortality (TRM). We used a random-effects model to calculate pooled hazard ratios (HRs) and relative risks (RRs) with 95% confidence intervals (CIs). Study quality was assessed using the Cochrane risk of bias tool and Newcastle-Ottawa Scale. Twelve studies involving 5057 patients met the inclusion criteria. Tandem ASCT was associated with a significantly higher CRR compared to single ASCT (HR 1.33, 95% CI 1.03-1.71, I2 = 15%), but no significant differences were observed in PFS (HR 0.75, 95% CI 0.42-1.34, I2 = 14%), OS (HR 0.60, 95% CI 0.33-1.10, I2 = 27%), or the ORR (RR 0.80, 95% CI 0.59-1.08, I2 = 33%). However, tandem ASCT was associated with a significantly higher risk of TRM (RR 1.78, 95% CI 1.00-3.18, I2 = 0%). Tandem ASCT improves the CRR but does not provide significant benefits in terms of PFS, OS, or ORR compared to single ASCT in patients with newly diagnosed MM. Moreover, tandem ASCT is associated with a higher risk of TRM. The decision to pursue tandem ASCT should be made on an individual basis, carefully weighing the potential benefits and risks in light of each patient's unique clinical situation. Future research should focus on identifying patient subgroups most likely to benefit from tandem ASCT and exploring strategies to optimize the efficacy and safety of this approach in the context of novel agent-based therapies.

Keywords: autologous stem cell transplantation; meta-analysis; multiple myeloma; tandem autologous transplantation.

Publication types

Review

Grants and funding

The authors disclosed that no support from any organization was received for the submitted work. Additionally, no funding was obtained to assist with the preparation of this manuscript nor was any funding received for conducting the study. This research was conducted solely through the authors’ own resources and dedication to advancing knowledge within the field.