Effects of induction with novel agents versus conventional chemotherapy on mobilization and autologous stem cell transplant outcomes in multiple myeloma. Leuk Lymphoma 2010 Feb;51(2):243-51
Date
12/30/2009Pubmed ID
20038230Pubmed Central ID
PMC3557809DOI
10.3109/10428190903480728Scopus ID
2-s2.0-76349087847 (requires institutional sign-in at Scopus site) 15 CitationsAbstract
Multiple myeloma (MM) is the top indication for high-dose chemotherapy (HDC) with autologous stem cell transplantation (SCT), a strategy which improves progression-free survival and potentially overall survival (OS). Novel induction regimens incorporating the immunomodulatory (IMID) agents, such as thalidomide and lenalidomide and the proteosome inhibitor bortezomib improve response rates and survival for newly diagnosed patients. Recent data temper enthusiasm for these treatments by illustrating difficulty in some circumstances with mobilizing CD34(+) hematopoietic stem cells for subsequent HDC/SCT. We compare conventional induction regimens with novel agent-based induction strategies and the associated effects on stem cell mobilization and HDC/SCT outcome in 224 patients. Although patients exposed to novel agent inductions collected generally fewer CD34(+) cells than patients induced with chemotherapy, these differences did not translate into adverse consequences with subsequent HDC/SCT. We show that an improvement in OS after HDC/SCT may be related to induction therapy with novel agents as opposed to chemotherapy. Our data extrapolate on prior work and expand on ongoing controversies about optimal induction regimens for patients with MM planned for subsequent HDC/SCT and optimal sequencing of therapies.
Author List
Benson DM Jr, Panzner K, Hamadani M, Hofmeister CC, Bakan CE, Smith MK, Elder P, Krugh D, O'Donnell L, Devine SMAuthor
Mehdi H. Hamadani MD Professor in the Medicine department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AgedAntigens, CD34
Antineoplastic Combined Chemotherapy Protocols
Boronic Acids
Bortezomib
Combined Modality Therapy
Dexamethasone
Doxorubicin
Female
Hematopoietic Stem Cell Mobilization
Hematopoietic Stem Cell Transplantation
Humans
Kaplan-Meier Estimate
Male
Middle Aged
Multiple Myeloma
Multivariate Analysis
Pyrazines
Thalidomide
Transplantation, Autologous
Vincristine