Superiority of bortezomib, thalidomide, and dexamethasone (VTD) as induction pretransplantation therapy in multiple myeloma: a randomized phase 3 PETHEMA/GEM study

Abstract

In an intention-to-treat analysis, the post-ASCT CR rate was higher with VTD than with TD (46% vs 24%, P ‫؍‬ .004) or with VBMCP/ VBAD/B (46% vs 38%, P ‫؍‬ .1). Patients with high-risk cytogenetics had a shorter PFS and overall survival in the overall series and in all treatment groups. In conclusion, VTD resulted in a higher preand posttransplantation CR rate and in a significantly longer PFS although it was not able to overcome the poor prognosis of high-risk cytogenetics. Our results support the use of VTD as a highly effective induction regimen prior to ASCT. The study was registered with http://www.clinicaltrials.gov (NCT00461747) and Eudra CT (no.

Efficacy, toxicity and mortality of autologous SCT in multiple myeloma patients with dialysis-dependent renal failure

“…22 Similar outcomes in non-dialysis populations have been reported by others. [23][24][25] However, ASCT appears to carry increased risk of toxicity in dialysis-dependent patients with a predisposition to atrial arrhythmias, delirium, mucositis and bleeding, as noted in our cohort and supported by other studies. 9,15 Interestingly, in the majority of patients with delirium, its onset coincided with the nadir of neutropenia.…”

A phase II, single-arm, prospective study of bendamustine plus melphalan conditioning for second autologous stem cell transplantation in de novo multiple myeloma patients through a tandem transplant strategy

“…4,[6][7][8][9]29 The transplant may be single or tandem (that is, second course of HDC within 6 months of the first) and the optimal strategy that routinely incorporates a tandem transplant remains an open question. 4,35,36 The IMWG suggests considering timely second ASCT in those patients who fail to achieve a VGPR or better after the first ASCT; 37 this clinical outcome is often used in some centers as the criterion for planning the tandem procedure.…”

“…2 For almost 25 years, therapeutic intensification with high-dose chemotherapy (HDC) and autologous stem cell transplantation (ASCT) has been considered as the standard of care in MM patients without significant comorbidities. 2,3 Although this approach is currently being debated by some investigators in the modern therapy era, 4 it still represents the standard treatment strategy; 5 and the incorporation of novel agents into different phases of the transplant procedure, including induction, [6][7][8][9] consolidation, 10,11 and maintenance 12,13 has substantially improved outcomes.…”

Consolidation and maintenance therapy for multiple myeloma after autologous transplantation: where do we stand?

“…5 However, not all the patients received bortezomib as part of induction therapy in this study, with bortezomib-based induction compared with non-bortezomib-containing regimens. It is as yet not clear which part of bortezomib exposure contributed most to the benefit seen.…”

“…Novel agents are now routinely utilized as part of the induction regimen before transplantation and this has resulted in substantial improvements in the depth of response achieved before transplant. [1][2][3][4][5][6][7][8] It is generally accepted that the depth of response is prognostic for overall outcome, [9][10][11][12] and this has been shown to be particularly pertinent in the transplant setting. Moreover, several analyses indicate that the achievement of complete response and in particular a minimal residual diseasenegative state post transplant is associated with prolonged PFS.…”