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Impact of response to thalidomide-, lenalidomide- or bortezomib- containing induction therapy on the outcomes of multiple myeloma patients undergoing autologous transplantation

Bone Marrow Transplantation volume 47, pages 146–148 (2012)Cite this article

High dose therapy and autologous transplantation (HDT-AT) has shown survival benefit for (at least) younger, transplant eligible multiple myeloma (MM) patients.1 Transplant ineligible patients who achieve a CR with novel chemotherapy agents, have recently been shown to have superior OS.2 However transplant eligible MM patients who have refractory disease in response to induction therapies (not containing novel agents) have never been shown to have inferior outcomes following HDT-AT, when compared with patients with chemosensitive disease.3, 4, 5, 6, 7 Whether this paradigm holds true in the era of novel agents requires prospective investigation. The Mayo Clinic group has8 retrospectively demonstrated that a <50% reduction in ‘serum M-protein’ after thalidomide or lenalidomide-based induction therapies, predicted inferior OS and progression-free survival (PFS) with HDT-AT. These findings require further validation in order to refine patient selection for HDT-AT.

We assessed the impact of pre-transplant remission status on outcomes of HDT-AT in MM patients receiving novel induction regimens, in a multicenter retrospective analysis. The study cohort consists of 127 consecutive patients who underwent a planned, single autologous transplant within 1-year of starting first-line induction chemotherapy containing at least one novel agent from 2003–2009. PBPCs were mobilized with CY and filgrastim. All patients received uniform conditioning with melphalan 200 mg/m2 intravenously on day −2 (melphalan 140 mg/m2 if serum creatinine was >2 mg/dL). The disease response pre- and post-transplantation was confirmed by two investigators at each participating institution by using standard criteria.9 Baseline categorical variables were compared by using Fisher's exact test, whereas continuous variables were compared by Wilcoxon rank-sum test or a two-sample t-test as appropriate. OS and PFS were estimated using the Kaplan–Meier method. OS was defined as the time from transplant to death from any cause, and surviving patients were censored at the last follow-up. PFS from transplantation was calculated using death and disease progression and/or relapse as events. This study was approved by IRB at all participating institutions. SPSS version 13.0 (IBM, Chicago, IL, USA) was used for statistical analysis.

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References

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Authors and Affiliations

  1. Division of Hematology-Oncology, Department of Internal Medicine, Medical College of Georgia, Augusta, GA, USA

    F T Awan, S T Kochuparambil & A Jillella

  2. Osborn Hematopoietic Malignancy and Transplantation Program, MBRCC, West Virginia University, Morgantown, WV, USA

    S Osman, L Gibson, S C Remick, J Abraham, M Craig & M Hamadani

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  1. F T Awan
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  2. S Osman
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  3. S T Kochuparambil
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  7. M Craig
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  9. M Hamadani
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Correspondence to M Hamadani.

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Awan, F., Osman, S., Kochuparambil, S. et al. Impact of response to thalidomide-, lenalidomide- or bortezomib- containing induction therapy on the outcomes of multiple myeloma patients undergoing autologous transplantation. Bone Marrow Transplant 47, 146–148 (2012). https://doi.org/10.1038/bmt.2011.18

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