Impact of Pretransplant Therapy and Depth of Disease Response before Autologous Transplantation for Multiple Myeloma

Ravi Vij, Shaji Kumar, Mei Jie Zhang, Xiaobo Zhong, Jiaxing Huang, Angela Dispenzieri, Muneer H. Abidi, Jennifer M. Bird, César O. Freytes, Robert Peter Gale, Tamila L. Kindwall-Keller, Robert A. Kyle, Daniel J. Landsburg, Hillard M. Lazarus, Reinhold Munker, Vivek Roy, Manish Sharma, Dan T. Vogl, Baldeep Wirk, Parameswaran N. Hari

Research output: Contribution to journalArticle

32 Citations (Scopus)

Abstract

Patients with multiple myeloma (MM) who are eligible for autologous stem cell transplantation (ASCT) typically receive a finite period of initial therapy before ASCT. It is not clear if patients with suboptimal (less than a partial) response to initial therapy benefit from additional alternative therapy with intent to maximize pretransplant response. We identified 539 patients with MM who had an ASCT after having achieved less than a partial response (PR) to first-line induction chemotherapy between 1995 and 2010. These patients were then divided into 2 groups: those who received additional salvage chemotherapy before ASCT (n=324) and those who had no additional salvage chemotherapy immediately before ASCT (n=215). Additional pretransplant chemotherapy resulted in deepening responses in 68% (complete response in 8% and PR in 60%). On multivariate analysis there was no impact of pretransplant salvage chemotherapy on treatment-related mortality, risk for relapse, progression-free survival, or overall survival. In conclusion, for patients achieving less than a PR to initial induction therapy, including with novel agent combinations, additional pre-ASCT salvage chemotherapy improved the depth of response and pre-ASCT disease status but was not associated with survival benefit.

Original languageEnglish (US)
Pages (from-to)335-341
Number of pages7
JournalBiology of Blood and Marrow Transplantation
Volume21
Issue number2
DOIs
StatePublished - Feb 1 2015

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Autologous Transplantation
Stem Cell Transplantation
Multiple Myeloma
Drug Therapy
Therapeutics
Induction Chemotherapy
Survival
Complementary Therapies
Disease-Free Survival
Multivariate Analysis
Recurrence
Mortality

All Science Journal Classification (ASJC) codes

  • Hematology
  • Transplantation

Cite this

Vij, Ravi ; Kumar, Shaji ; Zhang, Mei Jie ; Zhong, Xiaobo ; Huang, Jiaxing ; Dispenzieri, Angela ; Abidi, Muneer H. ; Bird, Jennifer M. ; Freytes, César O. ; Gale, Robert Peter ; Kindwall-Keller, Tamila L. ; Kyle, Robert A. ; Landsburg, Daniel J. ; Lazarus, Hillard M. ; Munker, Reinhold ; Roy, Vivek ; Sharma, Manish ; Vogl, Dan T. ; Wirk, Baldeep ; Hari, Parameswaran N. / Impact of Pretransplant Therapy and Depth of Disease Response before Autologous Transplantation for Multiple Myeloma. In: Biology of Blood and Marrow Transplantation. 2015 ; Vol. 21, No. 2. pp. 335-341.
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abstract = "Patients with multiple myeloma (MM) who are eligible for autologous stem cell transplantation (ASCT) typically receive a finite period of initial therapy before ASCT. It is not clear if patients with suboptimal (less than a partial) response to initial therapy benefit from additional alternative therapy with intent to maximize pretransplant response. We identified 539 patients with MM who had an ASCT after having achieved less than a partial response (PR) to first-line induction chemotherapy between 1995 and 2010. These patients were then divided into 2 groups: those who received additional salvage chemotherapy before ASCT (n=324) and those who had no additional salvage chemotherapy immediately before ASCT (n=215). Additional pretransplant chemotherapy resulted in deepening responses in 68{\%} (complete response in 8{\%} and PR in 60{\%}). On multivariate analysis there was no impact of pretransplant salvage chemotherapy on treatment-related mortality, risk for relapse, progression-free survival, or overall survival. In conclusion, for patients achieving less than a PR to initial induction therapy, including with novel agent combinations, additional pre-ASCT salvage chemotherapy improved the depth of response and pre-ASCT disease status but was not associated with survival benefit.",
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Vij, R, Kumar, S, Zhang, MJ, Zhong, X, Huang, J, Dispenzieri, A, Abidi, MH, Bird, JM, Freytes, CO, Gale, RP, Kindwall-Keller, TL, Kyle, RA, Landsburg, DJ, Lazarus, HM, Munker, R, Roy, V, Sharma, M, Vogl, DT, Wirk, B & Hari, PN 2015, 'Impact of Pretransplant Therapy and Depth of Disease Response before Autologous Transplantation for Multiple Myeloma', Biology of Blood and Marrow Transplantation, vol. 21, no. 2, pp. 335-341. https://doi.org/10.1016/j.bbmt.2014.10.023

Impact of Pretransplant Therapy and Depth of Disease Response before Autologous Transplantation for Multiple Myeloma. / Vij, Ravi; Kumar, Shaji; Zhang, Mei Jie; Zhong, Xiaobo; Huang, Jiaxing; Dispenzieri, Angela; Abidi, Muneer H.; Bird, Jennifer M.; Freytes, César O.; Gale, Robert Peter; Kindwall-Keller, Tamila L.; Kyle, Robert A.; Landsburg, Daniel J.; Lazarus, Hillard M.; Munker, Reinhold; Roy, Vivek; Sharma, Manish; Vogl, Dan T.; Wirk, Baldeep; Hari, Parameswaran N.

In: Biology of Blood and Marrow Transplantation, Vol. 21, No. 2, 01.02.2015, p. 335-341.

Research output: Contribution to journalArticle

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AU - Kumar, Shaji

AU - Zhang, Mei Jie

AU - Zhong, Xiaobo

AU - Huang, Jiaxing

AU - Dispenzieri, Angela

AU - Abidi, Muneer H.

AU - Bird, Jennifer M.

AU - Freytes, César O.

AU - Gale, Robert Peter

AU - Kindwall-Keller, Tamila L.

AU - Kyle, Robert A.

AU - Landsburg, Daniel J.

AU - Lazarus, Hillard M.

AU - Munker, Reinhold

AU - Roy, Vivek

AU - Sharma, Manish

AU - Vogl, Dan T.

AU - Wirk, Baldeep

AU - Hari, Parameswaran N.

PY - 2015/2/1

Y1 - 2015/2/1

N2 - Patients with multiple myeloma (MM) who are eligible for autologous stem cell transplantation (ASCT) typically receive a finite period of initial therapy before ASCT. It is not clear if patients with suboptimal (less than a partial) response to initial therapy benefit from additional alternative therapy with intent to maximize pretransplant response. We identified 539 patients with MM who had an ASCT after having achieved less than a partial response (PR) to first-line induction chemotherapy between 1995 and 2010. These patients were then divided into 2 groups: those who received additional salvage chemotherapy before ASCT (n=324) and those who had no additional salvage chemotherapy immediately before ASCT (n=215). Additional pretransplant chemotherapy resulted in deepening responses in 68% (complete response in 8% and PR in 60%). On multivariate analysis there was no impact of pretransplant salvage chemotherapy on treatment-related mortality, risk for relapse, progression-free survival, or overall survival. In conclusion, for patients achieving less than a PR to initial induction therapy, including with novel agent combinations, additional pre-ASCT salvage chemotherapy improved the depth of response and pre-ASCT disease status but was not associated with survival benefit.

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