TY - JOUR
T1 - Maintenance versus Induction Therapy Choice on Outcomes after Autologous Transplantation for Multiple Myeloma
AU - Cornell, Robert F.
AU - D'Souza, Anita
AU - Kassim, Adetola A.
AU - Costa, Luciano J.
AU - Innis-Shelton, Racquel D.
AU - Zhang, Mei Jie
AU - Huang, Jiaxing
AU - Abidi, Muneer
AU - Aiello, Jack
AU - Akpek, Gorgun
AU - Bashey, Asad
AU - Bashir, Qaiser
AU - Cerny, Jan
AU - Comenzo, Raymond
AU - Diaz, Miguel Angel
AU - Freytes, César
AU - Gale, Robert Peter
AU - Ganguly, Siddhartha
AU - Hamadani, Mehdi
AU - Hashmi, Shahrukh
AU - Holmberg, Leona
AU - Hossain, Nasheed
AU - Kamble, Rammurti T.
AU - Kharfan-Dabaja, Mohamed
AU - Kindwall-Keller, Tamila
AU - Kyle, Robert
AU - Kumar, Shaji
AU - Lazarus, Hillard
AU - Lee, Cindy
AU - Maiolino, Angelo
AU - Marks, David I.
AU - Meehan, Kenneth
AU - Mikhael, Joe
AU - Nath, Rajneesh
AU - Nishihori, Taiga
AU - Olsson, Richard F.
AU - Ramanathan, Muthalagu
AU - Saad, Ayman
AU - Seo, Sachiko
AU - Usmani, Saad
AU - Vesole, David
AU - Vij, Ravi
AU - Vogl, Dan
AU - Wirk, Baldeep M.
AU - Yared, Jean
AU - Krishnan, Amrita
AU - Mark, Tomer
AU - Nieto, Yago
AU - Hari, Parameswaran
N1 - Funding Information:
Financial disclosure: The CIBMTR is supported by Public Health Service Grant/Cooperative Agreement 5U24-CA076518 from the National Cancer Institute (NCI), the National Heart, Lung and Blood Institute (NHLBI), and the National Institute of Allergy and Infectious Diseases; Grant/Cooperative Agreement 5U10HL069294 from NHLBI and NCI; contract HHSH250201200016C with Health Resources and Services Administration (HRSA/DHHS); 2 grants N00014-15-1-0848 and N00014-16-1-2020 from the Office of Naval Research; and grants from Alexion; *Amgen, Inc.; Anonymous donation to the Medical College of Wisconsin; Astellas Pharma US; AstraZeneca; Be The Match Foundation; *Bluebird Bio, Inc.; *Bristol-Myers Squibb Oncology; *Celgene Corporation; Cellular Dynamics International, Inc.; *Chimerix, Inc.; Fred Hutchinson Cancer Research Center; Gamida Cell Ltd.; Genentech, Inc.; Genzyme Corporation; *Gilead Sciences, Inc.; Health Research, Inc. Roswell Park Cancer Institute; HistoGenetics, Inc.; Incyte Corporation; Janssen Scientific Affairs, LLC; *Jazz Pharmaceuticals, Inc.; Jeff Gordon Children's Foundation; The Leukemia and Lymphoma Society; Medac, GmbH; MedImmune; The Medical College of Wisconsin; *Merck & Co., Inc.; Mesoblast; MesoScale Diagnostics, Inc.; *Miltenyi Biotec, Inc.; National Marrow Donor Program; Neovii Biotech NA, Inc.; Novartis Pharmaceuticals Corporation; Onyx Pharmaceuticals; Optum Healthcare Solutions, Inc.; Otsuka America Pharmaceutical, Inc.; Otsuka Pharmaceutical Co., Ltd. ? Japan; PCORI; Perkin Elmer, Inc.; Pfizer, Inc; *Sanofi US; *Seattle Genetics; *Spectrum Pharmaceuticals, Inc.; St. Baldrick's Foundation; *Sunesis Pharmaceuticals, Inc.; Swedish Orphan Biovitrum, Inc.; Takeda Oncology; Telomere Diagnostics, Inc.; University of Minnesota; and *WellPoint, Inc. The views expressed in this article do not reflect the official policy or position of the National Institutes of Health, the Department of the Navy, the Department of Defense, the HRSA, or any other agency of the U.S. Government. *Corporate Members.
Publisher Copyright:
© 2017 The American Society for Blood and Marrow Transplantation
PY - 2017/2/1
Y1 - 2017/2/1
N2 - 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.
AB - 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.
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U2 - 10.1016/j.bbmt.2016.11.011
DO - 10.1016/j.bbmt.2016.11.011
M3 - Article
C2 - 27864161
AN - SCOPUS:85008193410
VL - 23
SP - 269
EP - 277
JO - Biology of Blood and Marrow Transplantation
JF - Biology of Blood and Marrow Transplantation
SN - 1083-8791
IS - 2
ER -