FACULTY COMMENTS
DR LONIAL: A number of trials have evaluated single versus
tandem transplant, and few have been positive. The French trial
was the only other positive trial for tandem transplant versus
single transplant with melphalan, and it demonstrated that
patients who had achieved a VGPR or better did not benefit from
a second transplant. So I believe many of us have adopted that
same approach. Patients who achieve a VGPR or better don’t
need a second cycle of high-dose therapy and transplant.
The Cavo trial showed that tandem transplant appeared to be superior to single transplant in terms of event-free survival and response rate. No real difference in seven-year overall survival was observed, but a difference at five years favoring double autologous transplant was seen.
My conclusion is that, for patients who fail to achieve a near CR — and in the French trial, a VGPR — a tandem transplant is of benefit.
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