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

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• 作者：Robert F. Cornell¹ ; Anita D'Souza² ; ^{andsouza@mcw.edu} ; Adetola A. Kassim¹ ; Luciano J. Costa³ ; Racquel D. Innis-Shelton³ ; Mei-Jie Zhang² ; ⁴ ; Jiaxing Huang² ; Muneer Abidi⁵ ; Jack Aiello⁶ ; Gorgun Akpek⁷ ; Asad Bashey⁸ ; Qaiser Bashir⁹ ; Jan Cerny¹⁰ ; Raymond Comenzo¹¹ ; Miguel Angel Diaz¹² ; Cé ; sar Freytes¹³ ; Robert Peter Gale¹⁴ ; Siddhartha Ganguly¹⁵ ; Mehdi Hamadani² ; Shahrukh Hashmi¹⁶ ; Leona Holmberg¹⁷ ; Nasheed Hossain¹⁸ ; Rammurti T. Kamble¹⁹ ; Mohamed Kharfan-Dabaja²⁰ ; Tamila Kindwall-Keller²¹ ; Robert Kyle¹⁶ ; Shaji Kumar¹⁶ ; Hillard Lazarus²² ; Cindy Lee²³ ; Angelo Maiolino²⁴ ; David I. Marks²⁵ ; Kenneth Meehan²⁶ ; Joe Mikhael²⁷ ; Rajneesh Nath¹⁰ ; Taiga Nishihori²⁰ ; Richard F. Olsson²⁸ ; ²⁹ ; Muthalagu Ramanathan¹⁰ ; Ayman Saad³ ; Sachiko Seo³⁰ ; Saad Usmani³¹ ; David Vesole³² ; Ravi Vij³³ ; Dan Vogl³⁴ ; Baldeep M. Wirk³⁵ ; Jean Yared³⁶ ; Amrita Krishnan³⁷ ; Tomer Mark³⁸ ; Yago Nieto⁹ ; Parameswaran Hari²
• 关键词：Myeloma ; Transplantation ; Survival ; Relapse ; Chemotherapy ; Maintenance
• 刊名：Biology of Blood and Marrow Transplantation
• 出版年：2017
• 出版时间：February 2017
• 年：2017
• 卷：23
• 期：2
• 页码：269-277
• 全文大小：1302 K
• 卷排序：23

文摘

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.