THE IMPACT OF INDUCTION THERAPY AND AUTOLOGOUS STEM CELL TRANSPLANTATION IN MULTIPLE MYELOMA ON TREATMENT OUTCOMES: A SINGLE CENTER EXPERIENCE
(Abstract release date: 05/21/15)
EHA Library. Pop V. 06/12/15; 102885; PB2040
Disclosure(s): Federal State Budgetary Institution Main Military Clinical Hospital named after ac. N.N. Burdenko of the Ministry of Defense of the Russian FederationHematology
Vasiliy Pop
Contributions
Contributions
Abstract
Abstract: PB2040
Type: Publication Only
Background
Treatment of symptomatic multiple myeloma (MM) in patients (pts) eligible for ASCT is a main approach, which can lead to a complete eradication of the tumor, improving or deepening of response, as well as increased survival rates.
Aims
The primary aim was to assess whether induction therapy and ASCT was associated with improved results on anti-tumor response and overall survival (OS). We also evaluated the impact of renal impairment and advanced stage of MM on OS in pts that underwent of ASCT.
Methods
The study included a cohort of pts with MM who underwent of ASCT for the period from 2001 to 2014. Induction therapy prior to ASCT included VAD-regimen and bortezomib-containing regimens with subsequent high-dose cyclophosphamide therapy. OS and progression free survival (PFS) estimated by the Kaplan-Meier method.
Results
The analyzed group consisted of 71pts with primary diagnosed MM (48 males/23 females; mean age 53.1 yrs (range 34-69). IgG MM was diagnosed in 39pts (55%), IgA MM in 13 (18%), Bence Jones myeloma in 16 (23%), primary plasma cell leukemia in 3pts (4%). In accordance with clinical stage, (Durie B.G.M. and Salmon S.E.) pts were distributed as follows: IA - 2 (2.8%), IIA - 23 (32.4%), IIB - 2 (2.8%), IIIA - 21 (29.6%), IIIB - 22 (31%). Induction therapy was VAD in 28pts (39.4%), bortezomib (VDD, VD) in 40 pts (56.4%), and VAD-like and VD in 3 pts (4.2%). The median of follow-up was 26.7m (3.1-126.2m). The cohort studied performed 83 ASCT. 12pts received 2 ASCT including planned tandem ASCT (n=6) and 2nd ASCT due to progression (n=6). Before the 1st ASCT complete response (CR) was observed in 21pts (29.6%) including 8 stringent CR, which was preserved when restaging after 3m. We identified improving the quality of response from a very good partial response (VGPR) and partial response (PR) to CR in 16 (37.2%) of 43pts after ASCT. 5pts with stable disease (SD) reached VGPR and PR. Of the 2pts transplanted in early biochemical relapse, 1 was reached CR, and the 2nd developed clinical relapse. Before the 2nd planned tandem ASCT performed with an interval of 3m (2-5m), in 3 of 6pts were reported CR, which hasn't changed during 3m. Of the remaining 3pts the achieved VGPR and CR preserved in 2pts. VGPR and PR was noted before the 2nd ASCT after relapse/progression in 5pts; 3m later 1 patient achieved CR, and 4pts showed no change. A patient with signs of disease progression after the 2nd ASCT achieved SD. The impact of induction therapy (with or without bortezomib) did not affect the results of survival (p=0.57). Renal impairment and advanced stage of MM as a poor prognostic factors also had no effect on the survival rate after ASCT (p=0.1). PFS and OS after ASCT (n=71) was 19.6m and 45.2m, respectively. OS from the diagnosis of MM was 58.5m. OS after 1st-line therapy (n=62) was 69m compared to 29m after 2nd-line (n=9), p=0.02. Median PFS after the 1st and 2nd line therapy did not differ (p=0.14). OS was significantly greater in the group of pts with CR after induction therapy (n=21) than with PR (n=43): 94 m vs 43 m, p=0.04. PFS for pts with CR before transplantation also exceeded PFS in pts with PR (34m vs 16m, p=0.05).
Summary
The depth (degree) of response to induction therapy was positively associated with survival rates. ASCT followed by high-dose chemotherapy demonstrated improving responses in a substantial proportion of patients not only after the first ASCT but also after the second ASCT (tandem or due to relapse of MM), which confirms the important role of ASCT. No survival benefit was seen for patients treated with ASCT in different regimens of induction chemotherapy and if they have renal impairment.
Keyword(s): Autologous hematopoietic stem cell transplantation, Induction chemotherapy, Multiple myeloma, Survival
Session topic: Publication Only
Type: Publication Only
Background
Treatment of symptomatic multiple myeloma (MM) in patients (pts) eligible for ASCT is a main approach, which can lead to a complete eradication of the tumor, improving or deepening of response, as well as increased survival rates.
Aims
The primary aim was to assess whether induction therapy and ASCT was associated with improved results on anti-tumor response and overall survival (OS). We also evaluated the impact of renal impairment and advanced stage of MM on OS in pts that underwent of ASCT.
Methods
The study included a cohort of pts with MM who underwent of ASCT for the period from 2001 to 2014. Induction therapy prior to ASCT included VAD-regimen and bortezomib-containing regimens with subsequent high-dose cyclophosphamide therapy. OS and progression free survival (PFS) estimated by the Kaplan-Meier method.
Results
The analyzed group consisted of 71pts with primary diagnosed MM (48 males/23 females; mean age 53.1 yrs (range 34-69). IgG MM was diagnosed in 39pts (55%), IgA MM in 13 (18%), Bence Jones myeloma in 16 (23%), primary plasma cell leukemia in 3pts (4%). In accordance with clinical stage, (Durie B.G.M. and Salmon S.E.) pts were distributed as follows: IA - 2 (2.8%), IIA - 23 (32.4%), IIB - 2 (2.8%), IIIA - 21 (29.6%), IIIB - 22 (31%). Induction therapy was VAD in 28pts (39.4%), bortezomib (VDD, VD) in 40 pts (56.4%), and VAD-like and VD in 3 pts (4.2%). The median of follow-up was 26.7m (3.1-126.2m). The cohort studied performed 83 ASCT. 12pts received 2 ASCT including planned tandem ASCT (n=6) and 2nd ASCT due to progression (n=6). Before the 1st ASCT complete response (CR) was observed in 21pts (29.6%) including 8 stringent CR, which was preserved when restaging after 3m. We identified improving the quality of response from a very good partial response (VGPR) and partial response (PR) to CR in 16 (37.2%) of 43pts after ASCT. 5pts with stable disease (SD) reached VGPR and PR. Of the 2pts transplanted in early biochemical relapse, 1 was reached CR, and the 2nd developed clinical relapse. Before the 2nd planned tandem ASCT performed with an interval of 3m (2-5m), in 3 of 6pts were reported CR, which hasn't changed during 3m. Of the remaining 3pts the achieved VGPR and CR preserved in 2pts. VGPR and PR was noted before the 2nd ASCT after relapse/progression in 5pts; 3m later 1 patient achieved CR, and 4pts showed no change. A patient with signs of disease progression after the 2nd ASCT achieved SD. The impact of induction therapy (with or without bortezomib) did not affect the results of survival (p=0.57). Renal impairment and advanced stage of MM as a poor prognostic factors also had no effect on the survival rate after ASCT (p=0.1). PFS and OS after ASCT (n=71) was 19.6m and 45.2m, respectively. OS from the diagnosis of MM was 58.5m. OS after 1st-line therapy (n=62) was 69m compared to 29m after 2nd-line (n=9), p=0.02. Median PFS after the 1st and 2nd line therapy did not differ (p=0.14). OS was significantly greater in the group of pts with CR after induction therapy (n=21) than with PR (n=43): 94 m vs 43 m, p=0.04. PFS for pts with CR before transplantation also exceeded PFS in pts with PR (34m vs 16m, p=0.05).
Summary
The depth (degree) of response to induction therapy was positively associated with survival rates. ASCT followed by high-dose chemotherapy demonstrated improving responses in a substantial proportion of patients not only after the first ASCT but also after the second ASCT (tandem or due to relapse of MM), which confirms the important role of ASCT. No survival benefit was seen for patients treated with ASCT in different regimens of induction chemotherapy and if they have renal impairment.
Keyword(s): Autologous hematopoietic stem cell transplantation, Induction chemotherapy, Multiple myeloma, Survival
Session topic: Publication Only
Abstract: PB2040
Type: Publication Only
Background
Treatment of symptomatic multiple myeloma (MM) in patients (pts) eligible for ASCT is a main approach, which can lead to a complete eradication of the tumor, improving or deepening of response, as well as increased survival rates.
Aims
The primary aim was to assess whether induction therapy and ASCT was associated with improved results on anti-tumor response and overall survival (OS). We also evaluated the impact of renal impairment and advanced stage of MM on OS in pts that underwent of ASCT.
Methods
The study included a cohort of pts with MM who underwent of ASCT for the period from 2001 to 2014. Induction therapy prior to ASCT included VAD-regimen and bortezomib-containing regimens with subsequent high-dose cyclophosphamide therapy. OS and progression free survival (PFS) estimated by the Kaplan-Meier method.
Results
The analyzed group consisted of 71pts with primary diagnosed MM (48 males/23 females; mean age 53.1 yrs (range 34-69). IgG MM was diagnosed in 39pts (55%), IgA MM in 13 (18%), Bence Jones myeloma in 16 (23%), primary plasma cell leukemia in 3pts (4%). In accordance with clinical stage, (Durie B.G.M. and Salmon S.E.) pts were distributed as follows: IA - 2 (2.8%), IIA - 23 (32.4%), IIB - 2 (2.8%), IIIA - 21 (29.6%), IIIB - 22 (31%). Induction therapy was VAD in 28pts (39.4%), bortezomib (VDD, VD) in 40 pts (56.4%), and VAD-like and VD in 3 pts (4.2%). The median of follow-up was 26.7m (3.1-126.2m). The cohort studied performed 83 ASCT. 12pts received 2 ASCT including planned tandem ASCT (n=6) and 2nd ASCT due to progression (n=6). Before the 1st ASCT complete response (CR) was observed in 21pts (29.6%) including 8 stringent CR, which was preserved when restaging after 3m. We identified improving the quality of response from a very good partial response (VGPR) and partial response (PR) to CR in 16 (37.2%) of 43pts after ASCT. 5pts with stable disease (SD) reached VGPR and PR. Of the 2pts transplanted in early biochemical relapse, 1 was reached CR, and the 2nd developed clinical relapse. Before the 2nd planned tandem ASCT performed with an interval of 3m (2-5m), in 3 of 6pts were reported CR, which hasn't changed during 3m. Of the remaining 3pts the achieved VGPR and CR preserved in 2pts. VGPR and PR was noted before the 2nd ASCT after relapse/progression in 5pts; 3m later 1 patient achieved CR, and 4pts showed no change. A patient with signs of disease progression after the 2nd ASCT achieved SD. The impact of induction therapy (with or without bortezomib) did not affect the results of survival (p=0.57). Renal impairment and advanced stage of MM as a poor prognostic factors also had no effect on the survival rate after ASCT (p=0.1). PFS and OS after ASCT (n=71) was 19.6m and 45.2m, respectively. OS from the diagnosis of MM was 58.5m. OS after 1st-line therapy (n=62) was 69m compared to 29m after 2nd-line (n=9), p=0.02. Median PFS after the 1st and 2nd line therapy did not differ (p=0.14). OS was significantly greater in the group of pts with CR after induction therapy (n=21) than with PR (n=43): 94 m vs 43 m, p=0.04. PFS for pts with CR before transplantation also exceeded PFS in pts with PR (34m vs 16m, p=0.05).
Summary
The depth (degree) of response to induction therapy was positively associated with survival rates. ASCT followed by high-dose chemotherapy demonstrated improving responses in a substantial proportion of patients not only after the first ASCT but also after the second ASCT (tandem or due to relapse of MM), which confirms the important role of ASCT. No survival benefit was seen for patients treated with ASCT in different regimens of induction chemotherapy and if they have renal impairment.
Keyword(s): Autologous hematopoietic stem cell transplantation, Induction chemotherapy, Multiple myeloma, Survival
Session topic: Publication Only
Type: Publication Only
Background
Treatment of symptomatic multiple myeloma (MM) in patients (pts) eligible for ASCT is a main approach, which can lead to a complete eradication of the tumor, improving or deepening of response, as well as increased survival rates.
Aims
The primary aim was to assess whether induction therapy and ASCT was associated with improved results on anti-tumor response and overall survival (OS). We also evaluated the impact of renal impairment and advanced stage of MM on OS in pts that underwent of ASCT.
Methods
The study included a cohort of pts with MM who underwent of ASCT for the period from 2001 to 2014. Induction therapy prior to ASCT included VAD-regimen and bortezomib-containing regimens with subsequent high-dose cyclophosphamide therapy. OS and progression free survival (PFS) estimated by the Kaplan-Meier method.
Results
The analyzed group consisted of 71pts with primary diagnosed MM (48 males/23 females; mean age 53.1 yrs (range 34-69). IgG MM was diagnosed in 39pts (55%), IgA MM in 13 (18%), Bence Jones myeloma in 16 (23%), primary plasma cell leukemia in 3pts (4%). In accordance with clinical stage, (Durie B.G.M. and Salmon S.E.) pts were distributed as follows: IA - 2 (2.8%), IIA - 23 (32.4%), IIB - 2 (2.8%), IIIA - 21 (29.6%), IIIB - 22 (31%). Induction therapy was VAD in 28pts (39.4%), bortezomib (VDD, VD) in 40 pts (56.4%), and VAD-like and VD in 3 pts (4.2%). The median of follow-up was 26.7m (3.1-126.2m). The cohort studied performed 83 ASCT. 12pts received 2 ASCT including planned tandem ASCT (n=6) and 2nd ASCT due to progression (n=6). Before the 1st ASCT complete response (CR) was observed in 21pts (29.6%) including 8 stringent CR, which was preserved when restaging after 3m. We identified improving the quality of response from a very good partial response (VGPR) and partial response (PR) to CR in 16 (37.2%) of 43pts after ASCT. 5pts with stable disease (SD) reached VGPR and PR. Of the 2pts transplanted in early biochemical relapse, 1 was reached CR, and the 2nd developed clinical relapse. Before the 2nd planned tandem ASCT performed with an interval of 3m (2-5m), in 3 of 6pts were reported CR, which hasn't changed during 3m. Of the remaining 3pts the achieved VGPR and CR preserved in 2pts. VGPR and PR was noted before the 2nd ASCT after relapse/progression in 5pts; 3m later 1 patient achieved CR, and 4pts showed no change. A patient with signs of disease progression after the 2nd ASCT achieved SD. The impact of induction therapy (with or without bortezomib) did not affect the results of survival (p=0.57). Renal impairment and advanced stage of MM as a poor prognostic factors also had no effect on the survival rate after ASCT (p=0.1). PFS and OS after ASCT (n=71) was 19.6m and 45.2m, respectively. OS from the diagnosis of MM was 58.5m. OS after 1st-line therapy (n=62) was 69m compared to 29m after 2nd-line (n=9), p=0.02. Median PFS after the 1st and 2nd line therapy did not differ (p=0.14). OS was significantly greater in the group of pts with CR after induction therapy (n=21) than with PR (n=43): 94 m vs 43 m, p=0.04. PFS for pts with CR before transplantation also exceeded PFS in pts with PR (34m vs 16m, p=0.05).
Summary
The depth (degree) of response to induction therapy was positively associated with survival rates. ASCT followed by high-dose chemotherapy demonstrated improving responses in a substantial proportion of patients not only after the first ASCT but also after the second ASCT (tandem or due to relapse of MM), which confirms the important role of ASCT. No survival benefit was seen for patients treated with ASCT in different regimens of induction chemotherapy and if they have renal impairment.
Keyword(s): Autologous hematopoietic stem cell transplantation, Induction chemotherapy, Multiple myeloma, Survival
Session topic: Publication Only
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