Stem cell transplantation in multiple myeloma: Impact of response failure with thalidomide or lenalidomide induction

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Abstract

Autologous stem cell transplantation as a platform for multiple myeloma treatment is the standard of care for patients who can safely withstand the procedure. Before novel agents were introduced, one-third to one-half of patients did not achieve partial response at transplantation. Previous medical literature has shown that in this past era, absence of initial response to induction therapy had no impact on progression-free survival and overall survival after high-dose therapy. Lack of response to initial induction did not preclude a good response after stem cell transplantation. With the introduction of novel agents - immunomodulatory drugs and proteasome inhibitors - response rates with initial therapy are now between 70% and 100%. This retrospective study analyzes progression-free survival and overall survival in patients who do not have a partial response (never responded or progressed during continuous therapy) after induction therapy with a regimen that contains thalidomide or lenalidomide. Unlike patients in reports published previously - before immunomodulatory drugs - patients who do not achieve partial remission have a significantly shorter overall survival from transplantation (73.5 vs 30.4 months) and a shorter progression-free survival (22.1 vs 13.1 months; P < .001). Absence of a response to induction therapy with thalidomide or lenalidomide predicts a poorer outcome after high-dose therapy.

Original languageEnglish (US)
Pages (from-to)2348-2353
Number of pages6
JournalBlood
Volume115
Issue number12
DOIs
StatePublished - Mar 25 2010

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Thalidomide
Stem Cell Transplantation
Stem cells
Multiple Myeloma
Proteasome Inhibitors
Pharmaceutical Preparations
Disease-Free Survival
Therapeutics
Survival
Transplantation
lenalidomide
Standard of Care
Retrospective Studies

ASJC Scopus subject areas

  • Biochemistry
  • Cell Biology
  • Immunology
  • Hematology

Cite this

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title = "Stem cell transplantation in multiple myeloma: Impact of response failure with thalidomide or lenalidomide induction",
abstract = "Autologous stem cell transplantation as a platform for multiple myeloma treatment is the standard of care for patients who can safely withstand the procedure. Before novel agents were introduced, one-third to one-half of patients did not achieve partial response at transplantation. Previous medical literature has shown that in this past era, absence of initial response to induction therapy had no impact on progression-free survival and overall survival after high-dose therapy. Lack of response to initial induction did not preclude a good response after stem cell transplantation. With the introduction of novel agents - immunomodulatory drugs and proteasome inhibitors - response rates with initial therapy are now between 70{\%} and 100{\%}. This retrospective study analyzes progression-free survival and overall survival in patients who do not have a partial response (never responded or progressed during continuous therapy) after induction therapy with a regimen that contains thalidomide or lenalidomide. Unlike patients in reports published previously - before immunomodulatory drugs - patients who do not achieve partial remission have a significantly shorter overall survival from transplantation (73.5 vs 30.4 months) and a shorter progression-free survival (22.1 vs 13.1 months; P < .001). Absence of a response to induction therapy with thalidomide or lenalidomide predicts a poorer outcome after high-dose therapy.",
author = "Morie Gertz and Kumar, {Shaji K} and Martha Lacy and Angela Dispenzieri and Dingli, {David M} and Hayman, {Suzanne R.} and Buadi, {Francis K.} and William Hogan",
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AU - Hogan, William

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