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Maintenance versus Induction Therapy Choice on Outcomes after Autologous Transplantation for Multiple Myeloma. Biol Blood Marrow Transplant 2017 Feb;23(2):269-277 PMID: 27864161 PMCID: PMC5346183

Pubmed ID

27864161

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%, Pā€‰=ā€‰.0001). This benefit was most evident in patients not achieving at least a complete response post-AHCT (Pā€‰=ā€‰.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.

Author List

Cornell RF, D'Souza A, Kassim AA, Costa LJ, Innis-Shelton RD, Zhang MJ, Huang J, Abidi M, Aiello J, Akpek G, Bashey A, Bashir Q, Cerny J, Comenzo R, Diaz MA, Freytes C, Gale RP, Ganguly S, Hamadani M, Hashmi S, Holmberg L, Hossain N, Kamble RT, Kharfan-Dabaja M, Kindwall-Keller T, Kyle R, Kumar S, Lazarus H, Lee C, Maiolino A, Marks DI, Meehan K, Mikhael J, Nath R, Nishihori T, Olsson RF, Ramanathan M, Saad A, Seo S, Usmani S, Vesole D, Vij R, Vogl D, Wirk BM, Yared J, Krishnan A, Mark T, Nieto Y, Hari P

Authors

Anita D'Souza MD Assistant Professor in the Medicine department at Medical College of Wisconsin
Mehdi H. Hamadani MD Professor in the Medicine department at Medical College of Wisconsin
Parameswaran Hari MD Chief, Professor in the Medicine department at Medical College of Wisconsin
Mei-Jie Zhang PhD Professor in the Institute for Health and Equity department at Medical College of Wisconsin




Scopus

2-s2.0-85008193410   6 Citations

MESH terms used to index this publication - Major topics in bold

Adolescent
Adult
Aged
Antineoplastic Combined Chemotherapy Protocols
Cause of Death
Combined Modality Therapy
Databases, Factual
Disease-Free Survival
Female
Hematopoietic Stem Cell Transplantation
Humans
Immunologic Factors
In Situ Hybridization, Fluorescence
Kaplan-Meier Estimate
Maintenance Chemotherapy
Male
Middle Aged
Multiple Myeloma
Neoplasms, Second Primary
Peripheral Nervous System Diseases
Proteasome Inhibitors
Remission Induction
Retrospective Studies
Transplantation, Autologous
Treatment Outcome
Young Adult
jenkins-FCD Prod-296 4db9d02597e0a2e889e230f853b641c12f1c3ee3