High-dose chemotherapy with hematopoietic stem-cell rescue for multiple myeloma.
This phase III study established the use of
high-dose melphalan supported by autologous stem cell transplant following chemotherapy.
Prof JA Child and Prof PJ Selby
Medical Research Council
A key randomised controlled trial evaluating both the clinical impact of high-dose chemotherapy using melphalan and the addition of autologous stem cell transplant (ASCT) in newly diagnosed patients. MRC Myeloma VII provided conclusive evidence that high-dose chemotherapy was effective for myeloma.
It showed that high-dose chemotherapy improved survival for patients under 65 years of age by 5% at five years, a finding which was confirmed by a meta-analysis with a simultaneous French trial.
The results of Myeloma VII – that high-dose chemotherapy with ASCT was a significant improvement on standard chemotherapy – was incorporated in UK and international clinical guidelines. This led to widespread changes in practice, as shown by an increase in the uptake of high-dose chemotherapy with autologous stem cell transplants in the UK rising from 211 in 1999 to 453 in 2005 and 1085 in 2014.
These changes were also seen internationally with a doubling of use of this treatment between 2003 and 2010.