{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T05:28:59Z","timestamp":1790832539546,"version":"4.1.0"},"reference-count":39,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2022,4,4]],"date-time":"2022-04-04T00:00:00Z","timestamp":1649030400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["acsjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cancer"],"published-print":{"date-parts":[[2022,6,15]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Despite routine evaluation of cytogenetics in myeloma, little is known regarding the impact of high\u2010dose therapy (HDT) consolidation on overall survival (OS) or progression\u2010free survival (PFS) in patients who have high\u2010risk cytogenetics. The authors performed a meta\u2010analysis of randomized controlled trials (RCTs) to assess the heterogeneity of HDT efficacy according to cytogenetic risk.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>All RCTs in patients who had newly diagnosed myeloma from 2000 to 2021 that compared upfront HDT versus standard\u2010dose therapy (SDT) consolidation were included. The primary objective was to assess the difference in HDT efficacy between standard\u2010risk and high\u2010risk cytogenetics in terms of the OS or PFS log(hazard ratio) (HR). The pooled OS and PFS HR was calculated according to cytogenetic\u2010risk subgroup using a random\u2010effects model, and heterogeneity (<jats:italic>I<\/jats:italic><jats:sup>2<\/jats:sup>) (the percentage of total observed variability explained by between\u2010study differences) was assessed using an interaction test.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>After screening 3307 citations, 6 RCTs were included for PFS analysis, and 4 were included for OS analysis. The median follow\u2010up ranged from 3.1 to 7.8 years. The pooled OS HR for HDT versus SDT consolidation in patients with standard\u2010risk and high\u2010risk cytogenetics was 0.90 (95% confidence interval [CI], 0.70\u20101.17; <jats:italic>I<\/jats:italic><jats:sup>2<\/jats:sup> = 0%) and 0.66 (95% CI, 0.45\u20100.97; <jats:italic>I<\/jats:italic><jats:sup>2<\/jats:sup> = 0%), respectively. The difference in HDT efficacy in terms of OS between standard\u2010risk and high\u2010risk patients was statistically significant in favor of the high\u2010risk group (<jats:italic>P<\/jats:italic> for interaction = .03). The pooled PFS HR for HDT versus SDT was 0.65 (95% CI 0.56\u20100.76; <jats:italic>I<\/jats:italic><jats:sup>2<\/jats:sup> = 0%) versus 0.52 (95% CI, 0.33\u20100.83; <jats:italic>I<\/jats:italic><jats:sup>2<\/jats:sup> = 55%), respectively. The difference in HDT efficacy in terms of PFS between standard\u2010risk and high\u2010risk patients was not significant (<jats:italic>P<\/jats:italic> for interaction = .25).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The magnitude of OS benefit with upfront HDT is cytogenetics\u2010dependent. Patients with high\u2010risk cytogenetics should preferably receive upfront rather than delayed HDT consolidation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Lay Summary<\/jats:title><jats:p>\n<jats:list list-type=\"bullet\">\n\n<jats:list-item><jats:p>Upfront autologous stem cell transplantation improves overall survival in patients with newly diagnosed myeloma harboring high\u2010risk cytogenetics.<\/jats:p><\/jats:list-item>\n<\/jats:list>\n<\/jats:p><\/jats:sec>","DOI":"10.1002\/cncr.34211","type":"journal-article","created":{"date-parts":[[2022,4,4]],"date-time":"2022-04-04T11:20:42Z","timestamp":1649071242000},"page":"2288-2297","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Impact of autologous transplantation on survival in patients with newly diagnosed multiple myeloma who have high\u2010risk cytogenetics: A meta\u2010analysis of randomized controlled trials"],"prefix":"10.1002","volume":"128","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7336-3003","authenticated-orcid":false,"given":"Rajshekhar","family":"Chakraborty","sequence":"first","affiliation":[{"name":"Multiple Myeloma and Amyloidosis Program Columbia University Irving Medical Center New York New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rabbia","family":"Siddiqi","sequence":"additional","affiliation":[{"name":"Internal Medicine Dow University of Health Sciences Karachi Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gloria","family":"Willson","sequence":"additional","affiliation":[{"name":"The Knowledge Center August C. Long Health Sciences Library Columbia University Irving Medical Center New York New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samiksha","family":"Gupta","sequence":"additional","affiliation":[{"name":"Internal Medicine University of Oklahoma Health Sciences Center Oklahoma City Oklahoma"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Noureen","family":"Asghar","sequence":"additional","affiliation":[{"name":"Internal Medicine Dow University of Health Sciences Karachi Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muhammad","family":"Husnain","sequence":"additional","affiliation":[{"name":"Division of Hematology\/Oncology University of Arizona Tucson Arizona"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammed A.","family":"Aljama","sequence":"additional","affiliation":[{"name":"Department of Oncology McMaster University Hamilton, Ontario 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