Efficacy of VDT PACE-like regimens in treatment of relapsed/refractory multiple myeloma

Arjun Lakshman, Preet Paul Singh, S Vincent Rajkumar, Angela Dispenzieri, Martha Lacy, Morie Gertz, Francis K. Buadi, David M Dingli, Yi Lisa Hwa, Amie L. Fonder, Miriam Hobbs, Suzanne R. Hayman, Steven R. Zeldenrust, John A. Lust, Stephen J Russell, Nelson Leung, Prashant Kapoor, Ronald S. Go, Yi Lin, Wilson Gonsalves & 4 others Taxiarchis Kourelis, Rahma Warsame, Robert A. Kyle, Shaji K Kumar

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Abstract

Experience with intensive chemotherapy for relapsed/refractory multiple myeloma (RRMM) using VDT PACE regimen and its modifications (VDT PACE-like regimens: VPLRs) outside TOTAL THERAPY trials is limited. We analyzed the outcomes of 141 patients with RRMM who received VPLRs at our center between 2006 and 2017 in an intent-to-treat analysis. Median age was 59.7 years and 66.7% of patients were male. A median of 2.2 years (range 0.02-11.4) separated diagnosis of myeloma and inititation of VPLR. High-risk cytogenetics were present in 52.4% patients. Patients received a median of 4 (range 1-14) prior therapies, including stem cell transplant (SCT) in 66.7% patients. Ninety-five (67.4%) patients received VDT PACE, 20 (14.2%) patients received VD PACE and 26 (18.4%) patients received other VPLRs. Patients received a median of 1 cycle (range 1-9) of VPLR. We observed ≥ minimal response in 68.4%, ≥ partial response (PR) in 54.4% and ≥ very good PR in 10.3% patients. Median progression-free survival was 3.1 months (95% CI, 1.9-3.9) and median overall survival (OS) was 8.1 months (CI, 6.2-9.9). One-hundred and sixteen (82.3%) patients received some therapy after VPLR; 71 (61.2%) received systemic chemotherapy, while 45 (38.8%) underwent SCT. Median OS for those who received SCT after VPLR was 15.1 months (CI, 10.3-20.8). Age ≥ 60 years (hazard ratio [HR] 2.3 [CI, 1.4-3.7]; P = 0.0008) and R-ISS III stage (HR- 2.4 [CI, 1.3-4.0]; P = 0.003) predicted shorter OS in patients receiving VPLR. VPLRs are effective in heavily pre-treated RRMM. In fit patients, SCT can be used to consolidate the response to VPLR.

Original languageEnglish (US)
Pages (from-to)179-186
Number of pages8
JournalAmerican Journal of Hematology
Volume93
Issue number2
DOIs
StatePublished - Feb 1 2018

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Multiple Myeloma
Therapeutics
Stem Cells
Transplants
Survival
Drug Therapy
Cytogenetics
Disease-Free Survival

ASJC Scopus subject areas

  • Hematology

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Efficacy of VDT PACE-like regimens in treatment of relapsed/refractory multiple myeloma. / Lakshman, Arjun; Singh, Preet Paul; Rajkumar, S Vincent; Dispenzieri, Angela; Lacy, Martha; Gertz, Morie; Buadi, Francis K.; Dingli, David M; Hwa, Yi Lisa; Fonder, Amie L.; Hobbs, Miriam; Hayman, Suzanne R.; Zeldenrust, Steven R.; Lust, John A.; Russell, Stephen J; Leung, Nelson; Kapoor, Prashant; Go, Ronald S.; Lin, Yi; Gonsalves, Wilson; Kourelis, Taxiarchis; Warsame, Rahma; Kyle, Robert A.; Kumar, Shaji K.

In: American Journal of Hematology, Vol. 93, No. 2, 01.02.2018, p. 179-186.

Research output: Contribution to journalArticle

Lakshman, Arjun ; Singh, Preet Paul ; Rajkumar, S Vincent ; Dispenzieri, Angela ; Lacy, Martha ; Gertz, Morie ; Buadi, Francis K. ; Dingli, David M ; Hwa, Yi Lisa ; Fonder, Amie L. ; Hobbs, Miriam ; Hayman, Suzanne R. ; Zeldenrust, Steven R. ; Lust, John A. ; Russell, Stephen J ; Leung, Nelson ; Kapoor, Prashant ; Go, Ronald S. ; Lin, Yi ; Gonsalves, Wilson ; Kourelis, Taxiarchis ; Warsame, Rahma ; Kyle, Robert A. ; Kumar, Shaji K. / Efficacy of VDT PACE-like regimens in treatment of relapsed/refractory multiple myeloma. In: American Journal of Hematology. 2018 ; Vol. 93, No. 2. pp. 179-186.
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abstract = "Experience with intensive chemotherapy for relapsed/refractory multiple myeloma (RRMM) using VDT PACE regimen and its modifications (VDT PACE-like regimens: VPLRs) outside TOTAL THERAPY trials is limited. We analyzed the outcomes of 141 patients with RRMM who received VPLRs at our center between 2006 and 2017 in an intent-to-treat analysis. Median age was 59.7 years and 66.7{\%} of patients were male. A median of 2.2 years (range 0.02-11.4) separated diagnosis of myeloma and inititation of VPLR. High-risk cytogenetics were present in 52.4{\%} patients. Patients received a median of 4 (range 1-14) prior therapies, including stem cell transplant (SCT) in 66.7{\%} patients. Ninety-five (67.4{\%}) patients received VDT PACE, 20 (14.2{\%}) patients received VD PACE and 26 (18.4{\%}) patients received other VPLRs. Patients received a median of 1 cycle (range 1-9) of VPLR. We observed ≥ minimal response in 68.4{\%}, ≥ partial response (PR) in 54.4{\%} and ≥ very good PR in 10.3{\%} patients. Median progression-free survival was 3.1 months (95{\%} CI, 1.9-3.9) and median overall survival (OS) was 8.1 months (CI, 6.2-9.9). One-hundred and sixteen (82.3{\%}) patients received some therapy after VPLR; 71 (61.2{\%}) received systemic chemotherapy, while 45 (38.8{\%}) underwent SCT. Median OS for those who received SCT after VPLR was 15.1 months (CI, 10.3-20.8). Age ≥ 60 years (hazard ratio [HR] 2.3 [CI, 1.4-3.7]; P = 0.0008) and R-ISS III stage (HR- 2.4 [CI, 1.3-4.0]; P = 0.003) predicted shorter OS in patients receiving VPLR. VPLRs are effective in heavily pre-treated RRMM. In fit patients, SCT can be used to consolidate the response to VPLR.",
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T1 - Efficacy of VDT PACE-like regimens in treatment of relapsed/refractory multiple myeloma

AU - Lakshman, Arjun

AU - Singh, Preet Paul

AU - Rajkumar, S Vincent

AU - Dispenzieri, Angela

AU - Lacy, Martha

AU - Gertz, Morie

AU - Buadi, Francis K.

AU - Dingli, David M

AU - Hwa, Yi Lisa

AU - Fonder, Amie L.

AU - Hobbs, Miriam

AU - Hayman, Suzanne R.

AU - Zeldenrust, Steven R.

AU - Lust, John A.

AU - Russell, Stephen J

AU - Leung, Nelson

AU - Kapoor, Prashant

AU - Go, Ronald S.

AU - Lin, Yi

AU - Gonsalves, Wilson

AU - Kourelis, Taxiarchis

AU - Warsame, Rahma

AU - Kyle, Robert A.

AU - Kumar, Shaji K

PY - 2018/2/1

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N2 - Experience with intensive chemotherapy for relapsed/refractory multiple myeloma (RRMM) using VDT PACE regimen and its modifications (VDT PACE-like regimens: VPLRs) outside TOTAL THERAPY trials is limited. We analyzed the outcomes of 141 patients with RRMM who received VPLRs at our center between 2006 and 2017 in an intent-to-treat analysis. Median age was 59.7 years and 66.7% of patients were male. A median of 2.2 years (range 0.02-11.4) separated diagnosis of myeloma and inititation of VPLR. High-risk cytogenetics were present in 52.4% patients. Patients received a median of 4 (range 1-14) prior therapies, including stem cell transplant (SCT) in 66.7% patients. Ninety-five (67.4%) patients received VDT PACE, 20 (14.2%) patients received VD PACE and 26 (18.4%) patients received other VPLRs. Patients received a median of 1 cycle (range 1-9) of VPLR. We observed ≥ minimal response in 68.4%, ≥ partial response (PR) in 54.4% and ≥ very good PR in 10.3% patients. Median progression-free survival was 3.1 months (95% CI, 1.9-3.9) and median overall survival (OS) was 8.1 months (CI, 6.2-9.9). One-hundred and sixteen (82.3%) patients received some therapy after VPLR; 71 (61.2%) received systemic chemotherapy, while 45 (38.8%) underwent SCT. Median OS for those who received SCT after VPLR was 15.1 months (CI, 10.3-20.8). Age ≥ 60 years (hazard ratio [HR] 2.3 [CI, 1.4-3.7]; P = 0.0008) and R-ISS III stage (HR- 2.4 [CI, 1.3-4.0]; P = 0.003) predicted shorter OS in patients receiving VPLR. VPLRs are effective in heavily pre-treated RRMM. In fit patients, SCT can be used to consolidate the response to VPLR.

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