Induction to Deepen Pre-transplant Response Does Not Improve OS in Multiple Myeloma
Study results suggest that many patients with multiple myeloma should proceed directly to autologous stem cell transplantation after first-line therapy.
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Pre-transplant induction therapy with lenalidomide, bortezomib, or carfilzomib did not improve overall survival (OS) among patients with multiple myeloma (MM), suggesting that many patients should proceed directly to autologous stem cell transplantation (ASCT) after first-line therapy, according to a study being presented at the 2017 American Society of Hematology Annual Meeting (ASH) in Atlanta, Georgia.1
For this study, researchers evaluated the outcomes of 496 patients with MM who underwent ASCT. All patients received dexamethasone, 86% of patients received a bortezomib-containing regimen, 70% received a lenalidomide-containing regimen, 61% received bortezomib plus lenalidomide, and 2% received a carfilzomib-containing regimen. Five percent of patients did not receive bortezomib, lenalidomide, or carfilzomib. The median follow-up time was 52.2 months.
There was no difference in overall survival (OS) among patients treated with bortezomib, lenalidomide, or carfilzomib as induction monotherapy or combination therapy compared with patients who did not receive these treatments (P = .4599).
Progressive disease (PD) at time of transplantation was significantly associated with a lower OS (P = .002), and no significant impact was observed among patients with a complete response (CR), a very good partial response (VGPR), a partial response (PR), or stable disease (SD). Of patients that did not have PD and received subsequent treatments to deepen their response, 29 had PD at time of transplantation.
The authors concluded that “our data supports continuing to second-line therapy only for patients in PD after first line. All other patients should proceed to mobilization and ASCT.”
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- Aleksidze N, McKiernan P, Siegel D, et al. Patients responding to any first line therapy for multiple myeloma should proceed to autologous stem cell transplantation instead of receiving second line therapy to deepen response. Poster presentation at: American Society of Hematology 59th Annual Meeting & Exposition; December 9-12, 2017; Atlanta, GA.