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

Robert F. Cornell, Anita D'Souza, Adetola A. Kassim, Luciano J. Costa, Racquel D. Innis-Shelton, Mei Jie Zhang, Jiaxing Huang, Muneer Abidi, Jack Aiello, Gorgun Akpek, Asad Bashey, Qaiser Bashir, Jan Cerny, Raymond Comenzo, Miguel Angel Diaz, César Freytes, Robert Peter Gale, Siddhartha Ganguly, Mehdi Hamadani, Shahrukh HashmiLeona Holmberg, Nasheed Hossain, Rammurti T. Kamble, Mohamed Kharfan-Dabaja, Tamila Kindwall-Keller, Robert Kyle, Shaji Kumar, Hillard Lazarus, Cindy Lee, Angelo Maiolino, David I. Marks, Kenneth Meehan, Joe Mikhael, Rajneesh Nath, Taiga Nishihori, Richard F. Olsson, Muthalagu Ramanathan, Ayman Saad, Sachiko Seo, Saad Usmani, David Vesole, Ravi Vij, Dan Vogl, Baldeep M. Wirk, Jean Yared, Amrita Krishnan, Tomer Mark, Yago Nieto, Parameswaran Hari

Research output: Contribution to journalArticle

13 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)269-277
Number of pages9
JournalBiology of Blood and Marrow Transplantation
Volume23
Issue number2
DOIs
StatePublished - Feb 1 2017

Keywords

  • Chemotherapy
  • Maintenance
  • Myeloma
  • Relapse
  • Survival
  • Transplantation

ASJC Scopus subject areas

  • Hematology
  • Transplantation

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    Cornell, R. F., D'Souza, A., Kassim, A. A., Costa, L. J., Innis-Shelton, R. D., Zhang, M. J., Huang, J., Abidi, M., Aiello, J., Akpek, G., Bashey, A., Bashir, Q., Cerny, J., Comenzo, R., Diaz, M. A., Freytes, C., Gale, R. P., Ganguly, S., Hamadani, M., ... Hari, P. (2017). Maintenance versus Induction Therapy Choice on Outcomes after Autologous Transplantation for Multiple Myeloma. Biology of Blood and Marrow Transplantation, 23(2), 269-277. https://doi.org/10.1016/j.bbmt.2016.11.011