The impact of induction regimen on transplant outcome in newly diagnosed multiple myeloma in the era of novel agents

Bone Marrow Transplant. 2017 Jan;52(1):34-40. doi: 10.1038/bmt.2016.214. Epub 2016 Aug 22.

Abstract

We compared overall survival (OS) of 1017 patients with newly diagnosed multiple myeloma (MM) who were treated with different novel agent-based induction regimens and who underwent early autologous stem cell transplant (ASCT). Subgroups were defined by type of induction therapy: cyclophosphamide-bortezomib-dexamethasone (CyBorD; n=193), bortezomib-dexamethasone (Vd; n=64), lenalidomide-dexamethasone (Rd; n=251), bortezomib-lenalidomide-dexamethasone (VRd; n=126), thalidomide-dexamethasone (Td; n=155) and vincristine-doxorubicin-dexamethasone or dexamethasone alone (VAD/Dex; n=228). The median follow-up of the surviving patients was 66.7 months. The 5-year OS rates with CyBorD, Vd, Rd, VRd, Td and VAD/Dex were 79.2%, 72.3%, 79.2%, 79.0%, 57.4% and 63.4%, respectively (log-rank, P<0.001). In a multivariate analysis, after controlling for important patient and disease variables, VRd had a superior OS compared with CyBorD (hazard ratio (HR), 0.32; 95% confidence interval (CI), 0.10-0.88; P=0.03) and Vd (HR, 0.16; 95% CI, 0.04-0.52; P=0.002). In conclusion, our study demonstrates that among patients completing induction therapy and continuing to early transplant, VRd induction leads to improved OS compared with CyBorD and Vd regimens.

Publication types

  • Clinical Trial
  • Comparative Study

MeSH terms

  • Adult
  • Aged
  • Antineoplastic Combined Chemotherapy Protocols / administration & dosage*
  • Autografts
  • Bortezomib / administration & dosage
  • Cyclophosphamide / administration & dosage
  • Dexamethasone / administration & dosage
  • Disease-Free Survival
  • Female
  • Humans
  • Induction Chemotherapy / methods*
  • Lenalidomide
  • Male
  • Middle Aged
  • Multiple Myeloma / mortality*
  • Multiple Myeloma / therapy*
  • Retrospective Studies
  • Stem Cell Transplantation*
  • Survival Rate
  • Thalidomide / administration & dosage
  • Thalidomide / analogs & derivatives
  • Transplantation Conditioning / methods*
  • Vincristine / administration & dosage

Substances

  • Thalidomide
  • Vincristine
  • Bortezomib
  • Dexamethasone
  • Cyclophosphamide
  • Lenalidomide