Bortezomib plus dexamethasone versus reduced-dose bortezomib, thalidomide plus dexamethasone as induction treatment before autologous stem cell transplantation in newly diagnosed multiple myeloma

Moreau, Philippe; Avet-Loiseau, Hervé; Façon, Thierry; Attal, Michel; Tiab, Mourad; Hulin, Cyrille; Doyen, Chantal; Garderet, Laurent; Randriamalala, Edouard; Araujo, Carla; Lepeu, G.; Marit, Gérald; Caillot, Denis; Escoffre, Martine; Lioure, Bruno; Benboubker, Lotfi; Pégourie, Brigitte; Kolb, Brigitte; Stoppa, Anne Marie; Fuzibet, J. G.; Decaux, Olivier; Dib, Mamoun; Berthou, Christian; Chaleteix, Carine; Sebban, Catherine; Traulle, Catherine; Fontan, Jean; Wetterwald, Marc; Lenain, Pascal; Mathiot, Claire; Harousseau, Jean‐Luc

doi:10.1182/blood-2011-05-355081

Cited by 272 publications

(184 citation statements)

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“…In randomized trials, VTD has shown better response rates and PFS compared with TD [58], as well as VD [59]. Results from randomized trials are not available for VRD and VCD, and the use of these two regimens in clinical practice is driven by promising results from Phase II studies.…”

Section: Risk-adapted Therapymentioning

confidence: 99%

Multiple myeloma: 2013 update on diagnosis, risk‐stratification, and management

2013

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Disease overviewMultiple myeloma accounts for approximately 10% of hematologic malignancies.DiagnosisThe diagnosis requires 10% or more clonal plasma cells on bone marrow examination or a biopsy proven plasmacytoma plus evidence of associated end‐organ damage. In addition, the presence of 60% or more clonal plasma cells in the marrow is also considered as myeloma regardless of the presence or absence of end‐organ damage.Risk stratificationIn the absence of concurrent trisomies, patients with 17p deletion, t(14;16), and t(14;20) are considered to have high‐risk myeloma. Patients with t(4;14) translocation are considered intermediate‐risk. All others are considered as standard‐risk.Risk‐adapted initial therapyStandard‐risk patients can be treated with lenalidomide plus low‐dose dexamethasone (Rd), or a bortezomib‐containing triplet such as bortezomib, cyclophosphamide, dexamethasone (VCD). Intermediate‐risk and high‐risk patients require a bortezomib‐based triplet regimen. In eligible patients, initial therapy is given for approximately 4 months followed by autologous stem cell transplantation (ASCT). Standard‐risk patients can opt for delayed ASCT if stem cells can be cryopreserved. In patients are not candidates for transplant, initial therapy is given for approximately 12–18 months.Maintenance therapyAfter initial therapy, lenalidomide maintenance is considered for standard‐risk patients who are not in very good partial response or better, while maintenance with a bortezomib‐based regimen should be considered in pateints with intermediate or high‐risk myeloma.Management of refractory diseasePatients with indolent relapse can be treated first with two‐drug or three‐drug combinations. Patients with more aggressive relapse often require therapy with a combination of multiple active agents. Am. J. Hematol. 88:225–235, 2013. © 2013 Wiley Periodicals, Inc.

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Section: Risk-adapted Therapymentioning

confidence: 99%

Multiple myeloma: 2013 update on diagnosis, risk‐stratification, and management

2013

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“…Novel therapies such as thalidomide, lenalidomide and bortezomib have all been used successfully for the management of relapsed as well as newly diagnosed MM. [5][6][7][8] However, patients eventually become refractory to these agents and prolonged treatment leads to significant toxicities, posing a challenge to physicians and highlighting the need for more effective salvage therapies.…”

Section: Introductionmentioning

confidence: 99%

Second auto-SCT for treatment of relapsed multiple myeloma

Gonsalves

Gertz

Lacy

et al. 2012

Bone Marrow Transplant

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High-dose therapy and auto-SCT remain integral in the initial treatment of multiple myeloma (MM), and are increasingly being applied for management of relapsed disease. We examined the outcomes in 98 patients undergoing salvage auto-SCT (auto-SCT2) for relapsed MM after receiving an initial transplant (auto-SCT1) between 1994 and 2009. The median age at auto-SCT2 was 60 years (range: 35-74). The median time between auto-SCT1 and auto-SCT2 was 46 months (range: 10-130). Treatment-related mortality was seen in 4%. The median PFS from auto-SCT2 was 10.3 (95% confidence interval (CI): 7-14) months and the median OS from auto-SCT2 was 33 months (95% CI: 28-51). In a multivariable analysis, shorter time to progression (TTP) after auto-SCT1, not achieving a CR after auto-SCT2, higher number of treatment regimens before auto-SCT2 and a higher plasma cell labeling index at auto-SCT2 predicted for shorter PFS. However, only a shorter TTP after auto-SCT1 predicted for a shorter OS post auto-SCT2. Hence, auto-SCT2 is an effective and feasible therapeutic option for MM patients relapsing after other treatments, especially in patients who had a TTP of at least 12 months after their auto-SCT1.

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“…The incidence of treatment-emergent peripheral neuropathy (PN) after the induction phase (16% grade 1-2, including 3% grade 2) was lower than that previously reported by the same group after four cycles of either vTD at the same doses but using intravenous (iv) bortezomib (53% all grades, including 14% grade 2 or higher) or iv standard dose bortezomib (1.3 mg/m 2 ) and dexamethasone (VD) (70% all grades, 34% >grade 2, 11% grade 3-4). 2 We report, herein, on the outcomes of 22 newly diagnosed, ASCT-eligible, MM patients who were programmed to receive at our center four 21-day cycles of sc bortezomib (1.3 mg/m 2 twice weekly) plus dexamethasone (total dose 320 mg per cycle) and either thalidomide (100 mg per day) (sc VTD: 13 patients) or cyclophosphamide (500 mg/m 2 on Days 1 and 8 per cycle) (sc VCD: 9 patients). All patients were prospectively evaluated for efficacy and toxicity of sc bortezomib-based induction therapy.…”

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confidence: 99%