Early versus delayed autologous stem cell transplant in patients receiving novel therapies for multiple myeloma

Abstract Autologous stem cell transplant (ASCT) is an effective treatment for multiple myeloma (MM). However, the timing of ASCT in the era of novel agents (lenalidomide, thalidomide, bortezomib) is unknown. We retrospectively reviewed the outcome of patients with MM who received novel agent-based i...

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Bibliographic Details
Published in:Leukemia & lymphoma 2013-08, Vol.54 (8), p.1658-1664
Main Authors: Dunavin, Neil C., Wei, Lai, Elder, Patrick, Phillips, Gary S., Benson, Don M., Hofmeister, Craig C., Penza, Sam, Greenfield, Carli, Rose, Karen S., Rieser, Gisele, Merritt, Lisa, Ketcham, Jill, Heerema, Nyla, Byrd, John C., Devine, Steven M., Efebera, Yvonne A.
Format: Article
Language:English
Subjects:
Adult
Aged
Antineoplastic Combined Chemotherapy Protocols - therapeutic use
Boronic Acids - administration & dosage
Bortezomib
Female
Hematopoietic Stem Cell Transplantation
Humans
Induction Chemotherapy
Lenalidomide
Male
Middle Aged
Multiple myeloma
Multiple Myeloma - drug therapy
Multiple Myeloma - mortality
Multiple Myeloma - pathology
Multiple Myeloma - therapy
Neoplasm Staging
Prognosis
Pyrazines - administration & dosage
Recurrence
Retrospective Studies
Thalidomide - administration & dosage
Thalidomide - analogs & derivatives
transplant
Transplantation, Autologous
Treatment Outcome
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Summary:Abstract Autologous stem cell transplant (ASCT) is an effective treatment for multiple myeloma (MM). However, the timing of ASCT in the era of novel agents (lenalidomide, thalidomide, bortezomib) is unknown. We retrospectively reviewed the outcome of patients with MM who received novel agent-based induction treatment and received first ASCT within 12 months of diagnosis (early ASCT, n = 102) or at a later date (late ASCT, n = 65). Median time to ASCT was 7.9 months vs. 17.7 months in early vs. late ASCT. The 3- and 5-year overall survival (OS) from diagnosis was 90 and 63% vs. 82 and 63% in early and late ASCT, respectively (p = 0.45). Forty-one and 36 patients in the early and late ASCT groups have relapsed or progressed, with median time to relapse of 28 and 23 months (p = 0.055). On multivariable analysis, factors predictive of increased risk for progression were International Scoring System (ISS) stage III (p = 0.007), and less than a very good partial response (< VGPR) post-ASCT (p < 0.001). A factor predictive of worst outcome for OS was being on hemodialysis (p = 0.037). No superiority of one agent was seen. In summary, early or late ASCT is a viable option for patients with MM receiving induction treatment with novel targeted therapies.
ISSN:1042-8194
1029-2403
DOI:10.3109/10428194.2012.751528