TY - JOUR
T1 - Impact of doublet post-transplant maintenance on outcomes in multiple myeloma
T2 - A propensity score matching analysis
AU - Huang, Ivan J.
AU - Baek, Grace T.
AU - Wu, Qian Vicky
AU - Chen, Gui Zhen
AU - Marzouk, Omar
AU - Cohen, Jonathan
AU - Kwok, Mary
AU - Banerjee, Rahul
AU - Cicero, Kara
AU - Basom, Ryan
AU - Holmberg, Leona
AU - Gopal, Ajay K.
AU - Qiao, Yang
AU - Cowan, Andrew J.
AU - Portuguese, Andrew J.
N1 - Publisher Copyright:
© The Author(s), under exclusive licence to Springer Nature Limited 2026.
PY - 2026
Y1 - 2026
N2 - Post-transplant maintenance therapy is a cornerstone of care for transplant-eligible patients with multiple myeloma (MM). While lenalidomide/bortezomib has been used as maintenance, clinical trials suggest that doublet maintenance may provide additional benefit, particularly in high-risk disease. Real-world evidence remains limited. We conducted a single-center retrospective analysis of patients with MM who underwent single autologous stem cell transplantation (ASCT) followed by maintenance therapy between 2015 and 2023. Doublet maintenance was defined as ≥2 agents and monotherapy maintenance as a single agent; dexamethasone was excluded from both definitions. The primary outcomes were event-free survival (EFS) and overall survival (OS). To mitigate treatment allocation bias, propensity score matching (PSM) was used to generate a pseudopopulation of monotherapy maintenance patients with characteristics comparable to those receiving doublet therapy. A total of 410 patients were included (doublet, n = 80; monotherapy, n = 330). The most common doublet and monotherapy regimens were bortezomib-lenalidomide (n = 46, 58%) and lenalidomide (n = 159, 48%), respectively. In the PSM analysis, doublet maintenance was associated with superior EFS (HR 0.58, p = 0.022; aHR 0.48, p = 0.007) and OS (HR 0.45, p = 0.022; aHR 0.47, p = 0.029). In this real-world analysis, doublet maintenance after ASCT was associated with superior EFS and OS, supporting broader consideration of this approach in MM.
AB - Post-transplant maintenance therapy is a cornerstone of care for transplant-eligible patients with multiple myeloma (MM). While lenalidomide/bortezomib has been used as maintenance, clinical trials suggest that doublet maintenance may provide additional benefit, particularly in high-risk disease. Real-world evidence remains limited. We conducted a single-center retrospective analysis of patients with MM who underwent single autologous stem cell transplantation (ASCT) followed by maintenance therapy between 2015 and 2023. Doublet maintenance was defined as ≥2 agents and monotherapy maintenance as a single agent; dexamethasone was excluded from both definitions. The primary outcomes were event-free survival (EFS) and overall survival (OS). To mitigate treatment allocation bias, propensity score matching (PSM) was used to generate a pseudopopulation of monotherapy maintenance patients with characteristics comparable to those receiving doublet therapy. A total of 410 patients were included (doublet, n = 80; monotherapy, n = 330). The most common doublet and monotherapy regimens were bortezomib-lenalidomide (n = 46, 58%) and lenalidomide (n = 159, 48%), respectively. In the PSM analysis, doublet maintenance was associated with superior EFS (HR 0.58, p = 0.022; aHR 0.48, p = 0.007) and OS (HR 0.45, p = 0.022; aHR 0.47, p = 0.029). In this real-world analysis, doublet maintenance after ASCT was associated with superior EFS and OS, supporting broader consideration of this approach in MM.
UR - https://www.scopus.com/pages/publications/105043783133
U2 - 10.1038/s41409-026-02955-5
DO - 10.1038/s41409-026-02955-5
M3 - Article
AN - SCOPUS:105043783133
SN - 0268-3369
JO - Bone Marrow Transplantation
JF - Bone Marrow Transplantation
ER -