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

Robert F. Cornell; Anita D'Souza; Adetola A. Kassim; Luciano J. Costa; Racquel D. Innis-Shelton; Mei Jie Zhang; Jiaxing Huang; Muneer Abidi; Jack Aiello; Gorgun Akpek; Asad Bashey; Qaiser Bashir; Jan Cerny; Raymond Comenzo; Miguel Angel Diaz; César Freytes; Robert Peter Gale; Siddhartha Ganguly; Mehdi Hamadani; Shahrukh Hashmi; Leona Holmberg; Nasheed Hossain; Rammurti T. Kamble; Mohamed Kharfan-Dabaja; Tamila Kindwall-Keller; Robert Kyle; Shaji Kumar; Hillard Lazarus; Cindy Lee; Angelo Maiolino; David I. Marks; Kenneth Meehan; Joe Mikhael; Rajneesh Nath; Taiga Nishihori; Richard F. Olsson; Muthalagu Ramanathan; Ayman Saad; Sachiko Seo; Saad Usmani; David Vesole; Ravi Vij; Dan Vogl; Baldeep M. Wirk; Jean Yared; Amrita Krishnan; Tomer Mark; Yago Nieto; Parameswaran Hari

doi:10.1016/j.bbmt.2016.11.011

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

Robert F. Cornell, Anita D'Souza, Adetola A. Kassim, Luciano J. Costa, Racquel D. Innis-Shelton, Mei Jie Zhang, Jiaxing Huang, Muneer Abidi, Jack Aiello, Gorgun Akpek, Asad Bashey, Qaiser Bashir, Jan Cerny, Raymond Comenzo, Miguel Angel Diaz, César Freytes, Robert Peter Gale, Siddhartha Ganguly, Mehdi Hamadani, Shahrukh HashmiLeona Holmberg, Nasheed Hossain, Rammurti T. Kamble, Mohamed Kharfan-Dabaja, Tamila Kindwall-Keller, Robert Kyle, Shaji Kumar, Hillard Lazarus, Cindy Lee, Angelo Maiolino, David I. Marks, Kenneth Meehan, Joe Mikhael, Rajneesh Nath, Taiga Nishihori, Richard F. Olsson, Muthalagu Ramanathan, Ayman Saad, Sachiko Seo, Saad Usmani, David Vesole, Ravi Vij, Dan Vogl, Baldeep M. Wirk, Jean Yared, Amrita Krishnan, Tomer Mark, Yago Nieto, Parameswaran Hari

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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 before autologous hematopoietic cell transplantation (AHCT) for multiple myeloma (MM) in the United States. 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 to 2013. Analysis was limited to those receiving a single AHCT after 1 line of induction therapy within 12 months from treatment initiation for MM. In multivariate analysis, progression-free survival (PFS) and overall survival were similar irrespective of induction regimen. However, high-risk cytogenetics and nonreceipt of post-transplant maintenance/consolidation therapy were associated with higher risk of relapse. Patients receiving post-transplant therapy had significantly improved 3-year PFS versus no post-transplant therapy (55% versus 39%, P = .0001). This benefit was most evident in patients not achieving at least a complete response post-AHCT (P = .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.

Original language	English
Pages (from-to)	269-277
Number of pages	9
Journal	Biology of Blood and Marrow Transplantation
Volume	23
Issue number	2
DOIs	https://doi.org/10.1016/j.bbmt.2016.11.011
State	Published - Feb 1 2017

Keywords

Chemotherapy
Maintenance
Myeloma
Relapse
Survival
Transplantation

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Cornell, R. F., D'Souza, A., Kassim, A. A., Costa, L. J., Innis-Shelton, R. D., Zhang, M. J., Huang, J., Abidi, M., Aiello, J., Akpek, G., Bashey, A., Bashir, Q., Cerny, J., Comenzo, R., Diaz, M. A., Freytes, C., Gale, R. P., Ganguly, S., Hamadani, M., ... Hari, P. (2017). Maintenance versus Induction Therapy Choice on Outcomes after Autologous Transplantation for Multiple Myeloma. Biology of Blood and Marrow Transplantation, 23(2), 269-277. https://doi.org/10.1016/j.bbmt.2016.11.011

@article{ac2846a8038044c0a3c9efe7fe31d6c5,

title = "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 before autologous hematopoietic cell transplantation (AHCT) for multiple myeloma (MM) in the United States. 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 to 2013. Analysis was limited to those receiving a single AHCT after 1 line of induction therapy within 12 months from treatment initiation for MM. In multivariate analysis, progression-free survival (PFS) and overall survival were similar irrespective of induction regimen. However, high-risk cytogenetics and nonreceipt of post-transplant maintenance/consolidation therapy were associated with higher risk of relapse. Patients receiving post-transplant therapy had significantly improved 3-year PFS versus no post-transplant therapy (55% versus 39%, P = .0001). This benefit was most evident in patients not achieving at least a complete response post-AHCT (P = .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.",

keywords = "Chemotherapy, Maintenance, Myeloma, Relapse, Survival, Transplantation",

author = "Cornell, {Robert F.} and Anita D'Souza and Kassim, {Adetola A.} and Costa, {Luciano J.} and Innis-Shelton, {Racquel D.} and Zhang, {Mei Jie} and Jiaxing Huang and Muneer Abidi and Jack Aiello and Gorgun Akpek and Asad Bashey and Qaiser Bashir and Jan Cerny and Raymond Comenzo and Diaz, {Miguel Angel} and C{\'e}sar Freytes and Gale, {Robert Peter} and Siddhartha Ganguly and Mehdi Hamadani and Shahrukh Hashmi and Leona Holmberg and Nasheed Hossain and Kamble, {Rammurti T.} and Mohamed Kharfan-Dabaja and Tamila Kindwall-Keller and Robert Kyle and Shaji Kumar and Hillard Lazarus and Cindy Lee and Angelo Maiolino and Marks, {David I.} and Kenneth Meehan and Joe Mikhael and Rajneesh Nath and Taiga Nishihori and Olsson, {Richard F.} and Muthalagu Ramanathan and Ayman Saad and Sachiko Seo and Saad Usmani and David Vesole and Ravi Vij and Dan Vogl and Wirk, {Baldeep M.} and Jean Yared and Amrita Krishnan and Tomer Mark and Yago Nieto and Parameswaran Hari",

note = "Publisher Copyright: {\textcopyright} 2017 The American Society for Blood and Marrow Transplantation",

year = "2017",

month = feb,

day = "1",

doi = "10.1016/j.bbmt.2016.11.011",

language = "English",

volume = "23",

pages = "269--277",

journal = "Biology of Blood and Marrow Transplantation",

issn = "1083-8791",

number = "2",

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Cornell, RF, D'Souza, A, Kassim, AA, Costa, LJ, Innis-Shelton, RD, Zhang, MJ, Huang, J, Abidi, M, Aiello, J, Akpek, G, Bashey, A, Bashir, Q, Cerny, J, Comenzo, R, Diaz, MA, Freytes, C, Gale, RP, Ganguly, S, Hamadani, M, Hashmi, S, Holmberg, L, Hossain, N, Kamble, RT, Kharfan-Dabaja, M, Kindwall-Keller, T, Kyle, R, Kumar, S, Lazarus, H, Lee, C, Maiolino, A, Marks, DI, Meehan, K, Mikhael, J, Nath, R, Nishihori, T, Olsson, RF, Ramanathan, M, Saad, A, Seo, S, Usmani, S, Vesole, D, Vij, R, Vogl, D, Wirk, BM, Yared, J, Krishnan, A, Mark, T, Nieto, Y & Hari, P 2017, 'Maintenance versus Induction Therapy Choice on Outcomes after Autologous Transplantation for Multiple Myeloma', Biology of Blood and Marrow Transplantation, vol. 23, no. 2, pp. 269-277. https://doi.org/10.1016/j.bbmt.2016.11.011

TY - JOUR

T1 - Maintenance versus Induction Therapy Choice on Outcomes after Autologous Transplantation for Multiple Myeloma

AU - Cornell, Robert F.

AU - D'Souza, Anita

AU - Kassim, Adetola A.

AU - Costa, Luciano J.

AU - Innis-Shelton, Racquel D.

AU - Zhang, Mei Jie

AU - Huang, Jiaxing

AU - Abidi, Muneer

AU - Aiello, Jack

AU - Akpek, Gorgun

AU - Bashey, Asad

AU - Bashir, Qaiser

AU - Cerny, Jan

AU - Comenzo, Raymond

AU - Diaz, Miguel Angel

AU - Freytes, César

AU - Gale, Robert Peter

AU - Ganguly, Siddhartha

AU - Hamadani, Mehdi

AU - Hashmi, Shahrukh

AU - Holmberg, Leona

AU - Hossain, Nasheed

AU - Kamble, Rammurti T.

AU - Kharfan-Dabaja, Mohamed

AU - Kindwall-Keller, Tamila

AU - Kyle, Robert

AU - Kumar, Shaji

AU - Lazarus, Hillard

AU - Lee, Cindy

AU - Maiolino, Angelo

AU - Marks, David I.

AU - Meehan, Kenneth

AU - Mikhael, Joe

AU - Nath, Rajneesh

AU - Nishihori, Taiga

AU - Olsson, Richard F.

AU - Ramanathan, Muthalagu

AU - Saad, Ayman

AU - Seo, Sachiko

AU - Usmani, Saad

AU - Vesole, David

AU - Vij, Ravi

AU - Vogl, Dan

AU - Wirk, Baldeep M.

AU - Yared, Jean

AU - Krishnan, Amrita

AU - Mark, Tomer

AU - Nieto, Yago

AU - Hari, Parameswaran

PY - 2017/2/1

Y1 - 2017/2/1

N2 - 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 before autologous hematopoietic cell transplantation (AHCT) for multiple myeloma (MM) in the United States. 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 to 2013. Analysis was limited to those receiving a single AHCT after 1 line of induction therapy within 12 months from treatment initiation for MM. In multivariate analysis, progression-free survival (PFS) and overall survival were similar irrespective of induction regimen. However, high-risk cytogenetics and nonreceipt of post-transplant maintenance/consolidation therapy were associated with higher risk of relapse. Patients receiving post-transplant therapy had significantly improved 3-year PFS versus no post-transplant therapy (55% versus 39%, P = .0001). This benefit was most evident in patients not achieving at least a complete response post-AHCT (P = .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.

AB - 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 before autologous hematopoietic cell transplantation (AHCT) for multiple myeloma (MM) in the United States. 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 to 2013. Analysis was limited to those receiving a single AHCT after 1 line of induction therapy within 12 months from treatment initiation for MM. In multivariate analysis, progression-free survival (PFS) and overall survival were similar irrespective of induction regimen. However, high-risk cytogenetics and nonreceipt of post-transplant maintenance/consolidation therapy were associated with higher risk of relapse. Patients receiving post-transplant therapy had significantly improved 3-year PFS versus no post-transplant therapy (55% versus 39%, P = .0001). This benefit was most evident in patients not achieving at least a complete response post-AHCT (P = .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.

KW - Chemotherapy

KW - Maintenance

KW - Myeloma

KW - Relapse

KW - Survival

KW - Transplantation

UR - http://www.scopus.com/inward/record.url?scp=85008193410&partnerID=8YFLogxK

U2 - 10.1016/j.bbmt.2016.11.011

DO - 10.1016/j.bbmt.2016.11.011

M3 - Article

C2 - 27864161

AN - SCOPUS:85008193410

SN - 1083-8791

VL - 23

SP - 269

EP - 277

JO - Biology of Blood and Marrow Transplantation

JF - Biology of Blood and Marrow Transplantation

IS - 2

ER -

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

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Keywords

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