2
|
Einsele H, Engelhardt M, Tapprich C, Müller J, Liebisch P, Langer C, Kropff M, Mügge LO, Jung W, Wolf HH, Metzner B, Hart C, Gramatzki M, Hertenstein B, Pfreundschuh M, Rösler W, Fischer T, Maschmeyer G, Kanz L, Hess G, Jäger E, Bentz M, Dürk HA, Salwender H, Hebart H, Straka C, Knop S. Phase II study of bortezomib, cyclophosphamide and dexamethasone as induction therapy in multiple myeloma: DSMM XI trial. Br J Haematol 2017; 179:586-597. [PMID: 28961309 DOI: 10.1111/bjh.14920] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 08/06/2017] [Indexed: 12/22/2022]
Abstract
We assessed the safety and efficacy of bortezomib, cyclophosphamide and dexamethasone (VCD) induction therapy in previously untreated multiple myeloma patients. A total of 414 patients received three 21-day cycles of VCD prior to autologous stem-cell transplantation (ASCT). Most common grade ≥3 adverse events were leucopenia (31·4%) and thrombocytopenia (6·8%). The overall response rate (ORR) by investigator-based assessment was 85·4%. Most patients (74%) underwent successful central laboratory-based molecular cytogenetic analysis. No clinically relevant differences in ORR post-induction were seen between patients with or without high-risk cytogenetic abnormalities (86·2% vs. 84·3%). Further follow-up data are available for 113 patients receiving ASCT who were included in a prospective consolidation trial (median follow-up, 55·5 months); median progression-free survival (PFS) was 35·3 months and median overall survival (OS) was not reached. In patients with high-risk versus standard-risk cytogenetics, median PFS was 19·9 vs. 43·6 months (P < 0·0001), and median OS was 54·7 months versus not reached (P = 0·0022). VCD is an effective and tolerable induction regimen; results suggest that VCD induces high response rates independently of cytogenetic risk status, but after long-term follow-up, cytogenetic high risk is associated with markedly reduced PFS and OS post-ASCT.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | - Wolfram Jung
- University Hospital Gottingen, Gottingen, Germany
| | | | - Bernd Metzner
- Klinikum Oldenburg, University Hospital, Oldenburg, Germany
| | | | | | | | | | - Wolf Rösler
- University Hospital Erlangen, Erlangen, Germany
| | | | | | - Lothar Kanz
- University Hospital Tübingen, Tübingen, Germany
| | - Georg Hess
- University Medical Centre of the Johannes Gutenberg University Mainz, Mainz, Germany
| | | | | | | | | | - Holger Hebart
- Stauferklinikum Schwäbisch Gmünd, Mutlangen, Germany
| | | | - Stefan Knop
- University Hospital Würzburg, Würzburg, Germany
| |
Collapse
|
3
|
Garderet L, Cook G, Auner HW, Bruno B, Lokhorst H, Perez-Simon JA, Sahebi F, Scheid C, Morris C, van Biezen A, Sobh M, Michallet M, Gahrton G, Schönland S, Kröger N. Treatment options for relapse after autograft in multiple myeloma – report from an EBMT educational meeting. Leuk Lymphoma 2016; 58:797-808. [DOI: 10.1080/10428194.2016.1228926] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
4
|
Ahn SY, Jung SH, Joo YD, Lee WS, Lee SM, Choi CW, Kim SJ, Kim K, Lee JJ. Early response-based intensification of primary therapy in newly diagnosed multiple myeloma patients who are eligible for autologous stem cell transplantation: phase II study. Ann Hematol 2014; 93:1571-7. [PMID: 24728664 DOI: 10.1007/s00277-014-2067-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Accepted: 03/18/2014] [Indexed: 10/25/2022]
Abstract
This phase II study prospectively evaluated the efficacy and tolerability of an early change in induction therapy before autologous stem cell transplantation (ASCT) in multiple myeloma (MM) patients who failed to achieve more than a partial response (PR) after two cycles of a cyclophosphamide, thalidomide, and dexamethasone (CTD) regimen. Patients aged 18-65 years received two cycles of CTD therapy, and then the patients who achieved more than a PR received two additional cycles of CTD therapy, while those who failed to achieve more than a PR were given intensified therapy with four cycles of a Vel-CD regimen (bortezomib, cyclophosphamide, and dexamethasone). After completing primary chemotherapy, the patients underwent ASCT. This study initially enrolled 64 patients, although four were excluded. Of the patients, 60 were treated with CTD regimen and 8 patients also had the intensified Vel-CD regimen, of whom five showing improved responses. The overall response rate before ASCT in 59 patients was 94.9 %, including 27.1 % with a stringent complete response/complete response, 23.7 % with a very good partial response (VGPR), and 44.1 % with a PR. The median time to progression (TTP) was 33.2 months (95 % CI, 26.6-34.8). Patients who attained a VGPR or better after ASCT tended to have a longer TTP than the patients who did not (not reached vs. 24.2 months, P = 0.04). In conclusion, early response-adapted intensification with a Vel-CD regimen was a well-tolerated, effective strategy for improving the response before ASCT in patients with newly diagnosed MM.
Collapse
Affiliation(s)
- Seo-Yeon Ahn
- Department of Hematology-Oncology, Chonnam National University Hwasun Hospital, 322 Seoyangro, Hwasun, Jeollanamdo, 519-763, Republic of Korea
| | | | | | | | | | | | | | | | | |
Collapse
|