Early versus delayed autologous transplantation after immunomodulatory agents-based induction therapy in patients with newly diagnosed multiple myeloma

Shaji K Kumar, Martha Lacy, Angela Dispenzieri, Francis K. Buadi, Suzanne R. Hayman, David M Dingli, Francesca Gay, Shirshendu Sinha, Nelson Leung, William Hogan, S Vincent Rajkumar, Morie Gertz

Research output: Contribution to journalArticle

84 Citations (Scopus)

Abstract

BACKGROUND: Early versus delayed autologous stem cell transplantation (SCT) results in comparable overall survival in patients with multiple myeloma (MM) who receive alkylator-based therapies. It is not clear whether this paradigm holds true in the context of new therapies, such as immunomodulatory drugs (IMiDs). METHODS: The authors studied 290 patients with untreated MM who received IMiD-based initial therapy, including 123 patients who received thalidomide-dexamethasone (TD) and 167 patients who received lenalidomide-dexamethasone (LD) induction before SCT. Patients who underwent a stem cell harvest attempt were considered transplantation-eligible and were included. SCT within 12 months of diagnosis and within 2 months of harvest were considered early SCT (n = 173; 60%). SCT >12 months after diagnosis was considered delayed SCT (n = 112; 40%). RESULTS: In the delayed SCT group, 42 patients had undergone SCT at the time of the current report, and the median estimated time to SCT was 5.3 months and 44.5 months in the early SCT and delayed SCT groups, respectively. The 4-year overall survival rate from diagnosis was 73% in both groups (P =.3) and was comparable in those who received TD (68% vs 64%, respectively) and those who received LD (82% vs 86%, respectively) as initial therapy. The time to progression after SCT was similar between the early and delayed SCT groups (20 months vs 16 months; P value nonsignificant). CONCLUSIONS: The current results indicated that, in transplantation-eligible patients who receive IMiDs as initial therapy followed by early stem cell mobilization, delayed SCT results in similar overall survival compared with early SCT. It is noteworthy that an excellent 4-year survival rate of >80% was observed among transplantation-eligible patients who received initial therapy with LD regardless of the timing of transplantation.

Original languageEnglish (US)
Pages (from-to)1585-1592
Number of pages8
JournalCancer
Volume118
Issue number6
DOIs
StatePublished - Mar 15 2012

Fingerprint

Autologous Transplantation
Stem Cell Transplantation
Multiple Myeloma
Dexamethasone
Therapeutics
Transplantation
Thalidomide
Survival Rate
Hematopoietic Stem Cell Mobilization
Survival
Alkylating Agents

Keywords

  • delayed transplantation
  • lenalidomide
  • multiple myeloma
  • stem cell transplantation
  • survival
  • thalidomide

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Early versus delayed autologous transplantation after immunomodulatory agents-based induction therapy in patients with newly diagnosed multiple myeloma. / Kumar, Shaji K; Lacy, Martha; Dispenzieri, Angela; Buadi, Francis K.; Hayman, Suzanne R.; Dingli, David M; Gay, Francesca; Sinha, Shirshendu; Leung, Nelson; Hogan, William; Rajkumar, S Vincent; Gertz, Morie.

In: Cancer, Vol. 118, No. 6, 15.03.2012, p. 1585-1592.

Research output: Contribution to journalArticle

@article{edbf4176c57e424eb5d058319bcbd861,
title = "Early versus delayed autologous transplantation after immunomodulatory agents-based induction therapy in patients with newly diagnosed multiple myeloma",
abstract = "BACKGROUND: Early versus delayed autologous stem cell transplantation (SCT) results in comparable overall survival in patients with multiple myeloma (MM) who receive alkylator-based therapies. It is not clear whether this paradigm holds true in the context of new therapies, such as immunomodulatory drugs (IMiDs). METHODS: The authors studied 290 patients with untreated MM who received IMiD-based initial therapy, including 123 patients who received thalidomide-dexamethasone (TD) and 167 patients who received lenalidomide-dexamethasone (LD) induction before SCT. Patients who underwent a stem cell harvest attempt were considered transplantation-eligible and were included. SCT within 12 months of diagnosis and within 2 months of harvest were considered early SCT (n = 173; 60{\%}). SCT >12 months after diagnosis was considered delayed SCT (n = 112; 40{\%}). RESULTS: In the delayed SCT group, 42 patients had undergone SCT at the time of the current report, and the median estimated time to SCT was 5.3 months and 44.5 months in the early SCT and delayed SCT groups, respectively. The 4-year overall survival rate from diagnosis was 73{\%} in both groups (P =.3) and was comparable in those who received TD (68{\%} vs 64{\%}, respectively) and those who received LD (82{\%} vs 86{\%}, respectively) as initial therapy. The time to progression after SCT was similar between the early and delayed SCT groups (20 months vs 16 months; P value nonsignificant). CONCLUSIONS: The current results indicated that, in transplantation-eligible patients who receive IMiDs as initial therapy followed by early stem cell mobilization, delayed SCT results in similar overall survival compared with early SCT. It is noteworthy that an excellent 4-year survival rate of >80{\%} was observed among transplantation-eligible patients who received initial therapy with LD regardless of the timing of transplantation.",
keywords = "delayed transplantation, lenalidomide, multiple myeloma, stem cell transplantation, survival, thalidomide",
author = "Kumar, {Shaji K} and Martha Lacy and Angela Dispenzieri and Buadi, {Francis K.} and Hayman, {Suzanne R.} and Dingli, {David M} and Francesca Gay and Shirshendu Sinha and Nelson Leung and William Hogan and Rajkumar, {S Vincent} and Morie Gertz",
year = "2012",
month = "3",
day = "15",
doi = "10.1002/cncr.26422",
language = "English (US)",
volume = "118",
pages = "1585--1592",
journal = "Cancer",
issn = "0008-543X",
publisher = "John Wiley and Sons Inc.",
number = "6",

}

TY - JOUR

T1 - Early versus delayed autologous transplantation after immunomodulatory agents-based induction therapy in patients with newly diagnosed multiple myeloma

AU - Kumar, Shaji K

AU - Lacy, Martha

AU - Dispenzieri, Angela

AU - Buadi, Francis K.

AU - Hayman, Suzanne R.

AU - Dingli, David M

AU - Gay, Francesca

AU - Sinha, Shirshendu

AU - Leung, Nelson

AU - Hogan, William

AU - Rajkumar, S Vincent

AU - Gertz, Morie

PY - 2012/3/15

Y1 - 2012/3/15

N2 - BACKGROUND: Early versus delayed autologous stem cell transplantation (SCT) results in comparable overall survival in patients with multiple myeloma (MM) who receive alkylator-based therapies. It is not clear whether this paradigm holds true in the context of new therapies, such as immunomodulatory drugs (IMiDs). METHODS: The authors studied 290 patients with untreated MM who received IMiD-based initial therapy, including 123 patients who received thalidomide-dexamethasone (TD) and 167 patients who received lenalidomide-dexamethasone (LD) induction before SCT. Patients who underwent a stem cell harvest attempt were considered transplantation-eligible and were included. SCT within 12 months of diagnosis and within 2 months of harvest were considered early SCT (n = 173; 60%). SCT >12 months after diagnosis was considered delayed SCT (n = 112; 40%). RESULTS: In the delayed SCT group, 42 patients had undergone SCT at the time of the current report, and the median estimated time to SCT was 5.3 months and 44.5 months in the early SCT and delayed SCT groups, respectively. The 4-year overall survival rate from diagnosis was 73% in both groups (P =.3) and was comparable in those who received TD (68% vs 64%, respectively) and those who received LD (82% vs 86%, respectively) as initial therapy. The time to progression after SCT was similar between the early and delayed SCT groups (20 months vs 16 months; P value nonsignificant). CONCLUSIONS: The current results indicated that, in transplantation-eligible patients who receive IMiDs as initial therapy followed by early stem cell mobilization, delayed SCT results in similar overall survival compared with early SCT. It is noteworthy that an excellent 4-year survival rate of >80% was observed among transplantation-eligible patients who received initial therapy with LD regardless of the timing of transplantation.

AB - BACKGROUND: Early versus delayed autologous stem cell transplantation (SCT) results in comparable overall survival in patients with multiple myeloma (MM) who receive alkylator-based therapies. It is not clear whether this paradigm holds true in the context of new therapies, such as immunomodulatory drugs (IMiDs). METHODS: The authors studied 290 patients with untreated MM who received IMiD-based initial therapy, including 123 patients who received thalidomide-dexamethasone (TD) and 167 patients who received lenalidomide-dexamethasone (LD) induction before SCT. Patients who underwent a stem cell harvest attempt were considered transplantation-eligible and were included. SCT within 12 months of diagnosis and within 2 months of harvest were considered early SCT (n = 173; 60%). SCT >12 months after diagnosis was considered delayed SCT (n = 112; 40%). RESULTS: In the delayed SCT group, 42 patients had undergone SCT at the time of the current report, and the median estimated time to SCT was 5.3 months and 44.5 months in the early SCT and delayed SCT groups, respectively. The 4-year overall survival rate from diagnosis was 73% in both groups (P =.3) and was comparable in those who received TD (68% vs 64%, respectively) and those who received LD (82% vs 86%, respectively) as initial therapy. The time to progression after SCT was similar between the early and delayed SCT groups (20 months vs 16 months; P value nonsignificant). CONCLUSIONS: The current results indicated that, in transplantation-eligible patients who receive IMiDs as initial therapy followed by early stem cell mobilization, delayed SCT results in similar overall survival compared with early SCT. It is noteworthy that an excellent 4-year survival rate of >80% was observed among transplantation-eligible patients who received initial therapy with LD regardless of the timing of transplantation.

KW - delayed transplantation

KW - lenalidomide

KW - multiple myeloma

KW - stem cell transplantation

KW - survival

KW - thalidomide

UR - http://www.scopus.com/inward/record.url?scp=84858001524&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84858001524&partnerID=8YFLogxK

U2 - 10.1002/cncr.26422

DO - 10.1002/cncr.26422

M3 - Article

C2 - 22009602

AN - SCOPUS:84858001524

VL - 118

SP - 1585

EP - 1592

JO - Cancer

JF - Cancer

SN - 0008-543X

IS - 6

ER -