COMPARISON OF SINGLE, TANDEM, AND SECOND AUTOLOGOUS STEM CELL TRANSPLANTATION IN PATIENTS WITH MULTIPLE MYELOMA AT SASKATCHEWAN CANCER AGENCY: A RETROSPECTIVE POPULATION-BASED STUDY
Bibliographic record
Abstract
Multiple myeloma (MM) is a malignant plasma cell disorder that ranks as the second most common hematological malignancy globally. It primarily affects older adults and poses a significant burden on both patients and healthcare systems due to its chronic relapsing nature and associated complications. For transplant-eligible patients, autologous stem cell transplantation (ASCT) is considered the standard of care and is typically performed following induction chemotherapy. While single ASCT has long been the conventional approach, emerging evidence suggests potential advantages of alternative transplant strategies, including tandem ASCT (two planned sequential transplants within 3-6 months) as an upfront therapy and second ASCT as a salvage therapy in relapsed disease. However, the comparative outcome and safety of these strategies, particularly in real-world settings, require additional scrutiny. This retrospective chart review study was conducted to compare the outcomes of single, tandem, and second ASCT among MM patients treated at Saskatchewan Cancer Agency (SCA) between 2010 and 2025. Data were collected from SCA database using REDCap and were analyzed using SPSS (version 27). Patients’ demographics, disease characteristics, baseline laboratory findings, and transplant details were assessed. The main aims of the study were overall survival, progression-free survival, and transplant-related mortality (TRM) in different transplant groups. The study also explored high-risk myeloma subgroup outcomes, as defined by International Myeloma Working Group (IMWG). A total of 211 patients were included and followed up for the mean period of 5.4 ± 3.3 years (range: 1–14 years). Patients were categorized into single ASCT (n = 166), tandem ASCT (n = 19), and second ASCT (n = 26) groups. Mean age of patients at diagnosis was 58.3 ± 7.7 years. Common comorbidities comprised diabetes (14.2%), chronic pulmonary disease (11.4%), and chronic kidney disease (10.9%). High-risk myeloma was present in 29.9% of the patients. At diagnosis, 71.1% had bone lesions, 58.6% had anemia, 26.1% had hypercalcemia, and 38.6% had renal insufficiency. The mean overall survival for single ASCT was 8.2 ± 0.4 years, for tandem ASCT was 7.7 ± 1.3 years, and for second ASCT was 11.0 ± 0.7 years (p = 0.117). Among high-risk myeloma patients (n = 63), the mean overall survival for single ASCT was 5.5 ± 0.7 years, for tandem ASCT was 3.5 ± 0.3 years, and for second ASCT was 7.9 ± 0.8 years (p = 0.057). The mean progression-free survival after first-line ASCT for single ASCT was 5.8 ± 0.4 years and for tandem ASCT 5.2 ± 1.0 years (p = 0.780). Among high-risk myeloma patients, the mean progression-free survival for single ASCT was 3.6 ± 0.5, and for tandem ASCT was 3.1 ± 0.4 years (p = 0.472). Upon progression following single ASCT, patients who received a second salvage ASCT had markedly longer progression-free survival compared to those who received non-transplant salvage treatments (3.4 ± 0.6 vs. 1.8 ± 0.3 years, respectively; p = 0.009). This advantage was also observed among the high-risk myeloma subgroup (3.2 ± 1.1 vs. 0.8 ± 0.2 years, respectively; p = 0.012). Only one TRM occurred after a second ASCT, which was 1.25% of total deaths (n = 80). In conclusion, this study provides real-world, population-based evidence comparing outcomes of single, tandem, and second ASCT in patients with MM, offering valuable insights for optimizing transplant strategies. While survival outcomes were similar between upfront single and tandem ASCT, patients who underwent a second ASCT after relapse experienced significantly longer progression-free survival compared to those who proceeded with non-transplant salvage treatments. Similarly, among high-risk myeloma patients, a second ASCT was associated with markedly improved progression-free survival. Overall, these results support the role of second ASCT as an effective and safe salvage approach, demonstrating favourable outcomes with minimal TRM rate.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.004 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".