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Maintenance versus Induction Therapy Choice on Outcomes after Autologous Transplantation for Multiple Myeloma.

ABSTRACT: Bortezomib (V), lenalidomide (R), cyclophosphamide (C), and dexamethasone (D) are components of the most commonly used modern doublet (RD, VD) or triplet (VRD, CVD) initial induction regimens before autologous hematopoietic cell transplantation (AHCT) for multiple myeloma (MM) in the United States. In this study we evaluated 693 patients receiving "upfront" AHCT after initial induction therapy with modern doublet or triplet regimens using data reported to the Center for International Blood and Marrow Transplant Research from 2008 to 2013. Analysis was limited to those receiving a single AHCT after 1 line of induction therapy within 12 months from treatment initiation for MM. In multivariate analysis, progression-free survival (PFS) and overall survival were similar irrespective of induction regimen. However, high-risk cytogenetics and nonreceipt of post-transplant maintenance/consolidation therapy were associated with higher risk of relapse. Patients receiving post-transplant therapy had significantly improved 3-year PFS versus no post-transplant therapy (55% versus 39%, P?=?.0001). This benefit was most evident in patients not achieving at least a complete response post-AHCT (P?=?.005). In patients receiving upfront AHCT, the choice of induction regimen (doublet or triplet therapies) appears to be of lower impact than use of post-transplant therapy.

SUBMITTER: Cornell RF

PROVIDER: S-EPMC5346183 | biostudies-literature | 2017 Feb

REPOSITORIES: biostudies-literature

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Maintenance versus Induction Therapy Choice on Outcomes after Autologous Transplantation for Multiple Myeloma.

Cornell Robert F RF D'Souza Anita A Kassim Adetola A AA Costa Luciano J LJ Innis-Shelton Racquel D RD Zhang Mei-Jie MJ Huang Jiaxing J Abidi Muneer M Aiello Jack J Akpek Gorgun G Bashey Asad A Bashir Qaiser Q Cerny Jan J Comenzo Raymond R Diaz Miguel Angel MA Freytes César C Gale Robert Peter RP Ganguly Siddhartha S Hamadani Mehdi M Hashmi Shahrukh S Holmberg Leona L Hossain Nasheed N Kamble Rammurti T RT Kharfan-Dabaja Mohamed M Kindwall-Keller Tamila T Kyle Robert R Kumar Shaji S Lazarus Hillard H Lee Cindy C Maiolino Angelo A Marks David I DI Meehan Kenneth K Mikhael Joe J Nath Rajneesh R Nishihori Taiga T Olsson Richard F RF Ramanathan Muthalagu M Saad Ayman A Seo Sachiko S Usmani Saad S Vesole David D Vij Ravi R Vogl Dan D Wirk Baldeep M BM Yared Jean J Krishnan Amrita A Mark Tomer T Nieto Yago Y Hari Parameswaran P

Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation 20161115 2

Bortezomib (V), lenalidomide (R), cyclophosphamide (C), and dexamethasone (D) are components of the most commonly used modern doublet (RD, VD) or triplet (VRD, CVD) initial induction regimens before autologous hematopoietic cell transplantation (AHCT) for multiple myeloma (MM) in the United States. In this study we evaluated 693 patients receiving "upfront" AHCT after initial induction therapy with modern doublet or triplet regimens using data reported to the Center for International Blood and M ...[more]

PMID: 27864161

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Project description:BackgroundInduction therapy followed by high-dose chemotherapy and autologous transplantation is the standard treatment for suitable patients with multiple myeloma.ObjectiveThe aim of this study was to assess whether induction therapy with thalidomidecontaining regimens was associated with improved results compared to vincristine, doxorubicin, and dexamethasone, and whether cyclophosphamide, thalidomide, and dexamethasone were associated with better results than thalidomide and dexamethasone.MethodsThe records of 152 patients who underwent autologous transplantation at this institution from August of 2004 to January of 2012 were reviewed, selecting those with at least partial response to a maximum of eight cycles of induction therapy and sufficient follow-up information for analysis.ResultsThis study included 89 patients; 44 were female, with a mean age of 55 years (there was a significant trend for increasing age over the years of the study).The median number of induction therapy cycles was four, again with a trend of increase over the years.At least a very good partial response to induction therapy was achieved more often in the cyclophosphamide, thalidomide, and dexamethasone group (61.1%) and in the thalidomide and dexamethasone group (59.2%) than in the vincristine, doxorubicin, and dexamethasone group (16.2%). The overall median progression-free survival was 34 months, with no statistically significant difference between the three groups. The overall median survival was not reached, and there was no significant difference between the three groups; the estimated five-year overall survival was 55%.ConclusionAlthough the quality of responses appeared to be better with thalidomidecontaining regimens, these improvements did not translate into improved long-term outcomes. Given its track record, cyclophosphamide, thalidomide, and dexamethasone is currently considered the preferred regimen for first-line induction therapy in the Brazilian public health system.

Dataset Information

Maintenance versus Induction Therapy Choice on Outcomes after Autologous Transplantation for Multiple Myeloma.

Publications

Maintenance versus Induction Therapy Choice on Outcomes after Autologous Transplantation for Multiple Myeloma.

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