Thread by @VincentRK

#ASH20 IFM 2009 trial results presented by @PerrotAurore

On intent to treat basis early and delayed stem cell transplantation led to identical overall survival at 8 years. Timely given the pandemic situation. See thread on what these results mean. #ASH20VR @ASH_hematology

Important to note that higher PFS,better MRD- with early transplant, and the fact that not everyone who was randomized to delayed transplant did not manage to affect the probability of staying alive at 8 years one bit. #ASH20

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Nevertheless, I still recommend early transplant for most eligible patients for reasons discussed in this thread.

https://twitter.com/vincentrk/status/1334520990898991110

It is intriguing that just 3 extra cycles of VRD neutralizes the 8 year overall survival probability of auto transplant. Also this trial used only 1 year of maintenance. DFCI trial will tell us if the PFS benefit of early transplant shrinks with Len maintenance until progression.

When survival at 8 years is the same there are 4 possibilities:

1) The difference is in the tail & may emerge later
2) There’s truly no difference in survival, whichever option u choose
3) There is imbalance in feasibility of salvage therapy between arms
4) Trial is underpowered

This should read:
Important to note that higher PFS,better MRD- with early transplant, and the fact that not everyone who was randomized to delayed transplant even got a transplant did not manage to affect the probability of staying alive at 8 years one bit. #ASH20