Maintenance versus Induction Therapy Choice on Outcomes after Autologous Transplantation for Multiple Myeloma

Abstract

Bortezomib (V), lenalidomide (R), cyclophosphamide (C) and dexamethasone (D) are components of the most commonly used modern doublet (RD, VD) or triplet (VRD, CVD) initial induction regimens prior to autologous hematopoietic cell transplantation (AHCT) for multiple myeloma (MM) in the US. In this study we evaluated 693 patients receiving “upfront” AHCT after initial induction therapy with modern doublet or triplet regimens using data reported to the Center for International Blood and Marrow Transplant Research from 2008–2013. Analysis was limited to those receiving a single AHCT after one line of induction therapy within 12 months from treatment initiation for MM. In multivariate analysis, progression-free (PFS) and overall survival were similar irrespective of induction regimen. However high risk cytogenetics and non-receipt of post-transplant maintenance/consolidation therapy were associated with higher risk of relapse. Patients receiving post-transplant therapy had significantly improved 3-year PFS vs. no post-transplant therapy (55% vs. 39%, p=0.0001). This benefit was most evident in patients not achieving at least CR post-AHCT (p=0.005). In patients receiving upfront AHCT, the choice of induction regimen (doublet or triplet therapies) appears to be of lower impact than use of post-transplant therapy.

Impact of lenalidomide‐based induction therapy on the mobilization of CD34+ cells, blood graft cellular composition, and post‐transplant recovery in myeloma patients: a prospective multicenter study

“…PFS was significantly better in the LEN(+) group, although the groups were small, and only 53% of patients in the LEN(+) group received LEN maintenance as a part of the Phase 2 study. A recent study suggested that post‐transplant maintenance was more important than the type of induction regimen used in patients with MM . In our study, patients who received LEN‐based induction and LEN maintenance did not have significantly better PFS compared with those who did not receive maintenance, although the groups were very small.…”

Retrospective analysis of the efficacy and influencing factors of autologous hematopoietic stem cell transplantation for multiple myeloma

“…However, the effect on OS rates was not statistically significant ( P = 0.485), which may be associated with fewer cases in the traditional regimen. Moreover, some researchers have considered that the consolidation and maintenance therapy after transplantation is especially important for the long‐term survival of patients who have not reached CR after transplantation . It is noteworthy that in the present study, 1 patient was in PR after 3 recurrences following traditional drug chemotherapy before transplantation.…”

Bortezomib‐based therapy for relapsed/refractory multiple myeloma in real‐world medical practice

“…Age, line of therapy at bortezomib initiation, baseline renal function, disease stage, and depth of best response appeared prognostic for PFS and OS in this study; several of these parameters have also been identified as prognostic for outcomes in the clinical trial setting . Of note, the distributions of PFS or OS when stratified by best response were not markedly affected by response criteria.…”