Sequence of novel agents in multiple myeloma: An instrumental variable analysis

Abstract Lenalidomide and bortezomib have not been compared prospectively and are currently used in sequence for patients with multiple myeloma; however, it is unknown whether a sequence of administration could result in improved outcomes. We retrospectively reviewed electronic records of patients w...

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Bibliographic Details
Published in:Leukemia research 2013-09, Vol.37 (9), p.1077-1082
Main Authors: Baz, Rachid, Miladinovic, Branko, Patel, Amila, Ho, Viet Q, Shain, Kenneth H, Alsina, Melissa, Nishihori, Taiga, Ochoa-Bayona, Jose L, Sullivan, Daniel M, Dalton, William S, Djulbegovic, Benjamin
Format: Article
Language:English
Subjects:
Adult
Aged
Aged, 80 and over
Antineoplastic Combined Chemotherapy Protocols - therapeutic use
Boronic Acids - administration & dosage
Bortezomib
Drug Administration Schedule
Female
Follow-Up Studies
Hematology, Oncology and Palliative Medicine
Humans
Lenalidomide
Male
Middle Aged
Multiple myeloma
Multiple Myeloma - drug therapy
Multiple Myeloma - mortality
Neoplasm Recurrence, Local - drug therapy
Neoplasm Recurrence, Local - mortality
Outcome
Prognosis
Pyrazines - administration & dosage
Remission Induction
Retrospective Studies
Survival
Survival Rate
Thalidomide - administration & dosage
Thalidomide - analogs & derivatives
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Summary:Abstract Lenalidomide and bortezomib have not been compared prospectively and are currently used in sequence for patients with multiple myeloma; however, it is unknown whether a sequence of administration could result in improved outcomes. We retrospectively reviewed electronic records of patients with multiple myeloma who had used both agents in sequence at our institution: 97 patients had lenalidomide first and 111 had bortezomib first. On multivariable analysis, the sequence of therapy was not associated with outcome. These findings were confirmed with instrumental variable analyses. Finally, use of bortezomib first was associated with improved survival for patients with baseline renal insufficiency.
ISSN:0145-2126
1873-5835
DOI:10.1016/j.leukres.2013.06.005