HIGH RESPONSE RATES BUT INEFFECTIVE PRE-SELECTION STRATEGIES FOR TREATMENT WITH HDM AND AUTOLOGOUS STEM CELL TRANSPLANTATION IN PATIENTS WITH MULTIPLE MYELOMA BETWEEN 65-70 YEARS IN THE NETHERLANDS
(Abstract release date: 05/19/16)
EHA Library. Brink M. 06/09/16; 132828; E1279
Dr. Mirian Brink
Contributions
Contributions
Abstract
Abstract: E1279
Type: Eposter Presentation
Background
The Dutch national clinical guideline recommends bortezomib-based induction chemotherapy (inductionCT) followed by high dose melfalan (HDM) and autologous stem cell transplantation (ASCT) for patients with symptomatic multiple myeloma (symMM) aged ≤65 years. In addition, ASCT should also be considered for patients with symMM aged 66-70 years.
Aims
To evaluate how these recommendations were applied in daily practice in the Netherlands for patients with symMM aged ≤70 years and, secondly, what percentage of patients aged 66-70 years was offered ASCT as their first line treatment.
Methods
From the nationwide population-based Netherlands Cancer Registry, we identified 476 patients aged ≤70 years diagnosed with symMM in 2014 (60% male). Of these patients, 318 (67%) were ≤65 years and 158 (33%) were 66-70 years. InductionCT was defined as bortezomib-based chemotherapy regimens (i.e. BD, PAD, VCD or VTD) with or without (+/-) subsequent HDM and ASCT. Overall response rate (ORR) was defined as achieving complete or partial response i.e. CR, VGPR and PR as best achieved response outcome. Data were analyzed for the total cohort, as well as stratified by age at diagnosis.
Results
Overall, of patients ≤65 years, 283 (89%) were treated with inductionCT, of which VCD was most frequently used (N=231/283;82%), followed by PAD (N=30/283;11%) and BD (N=22/283;8%). The remaining patients received other types of chemotherapeutic regimens (2%) or no chemotherapy at all (9%). Of patients who received inductionCT, 217 of 283 (77%) received the planned HDM+ASCT.Of patients aged 66-70 years, 61 (39%) received inductionCT consisting of either VCD (N=38/61;62%), BD (N=19/61;31%) or PAD (N=4/61;7%). The remaining patients were mostly treated with VMP (N=77/158;49%), while 8% (N=13/158) did not receive any treatment. In contrast to patients aged ≤65 years, only 29 of 61 (48%) patients underwent ASCT after inductionCT.The ORRs were 86% (242/283) and 72% (44/61) for patients ≤65 and 66-70 years who received inductionCT +/- ASCT, respectively. The ORR for patients aged 66-70 years who received VMP was 34% (26/77), which is markedly lower than previously reported in the VISTA trial (ORR, 71%). The ORR for patients who received inductionCT, but did not proceed to ASCT was lower as compared to patients who did proceed to ASCT (51% vs 96%) irrespective of age group. Moreover, the ORR of patients aged 66-70 years who received inductionCT (+/- ASCT) was higher than the ORR of patients in the same age group who received VMP (72% vs 34%).
Conclusion
Our results show that most patients aged ≤65 years start with inductionCT and 77% of these are able to proceed to HDM+ASCT. In addition, among patients aged 66-70 years, 39% start with inductionCT of whom only 48% received subsequent ASCT. Although based on modest patient numbers, the ORR of inductionCT +/- ASCT in patients between 66-70 years was lower as compared to the ORR in the younger patient group, while higher than the ORR in the VMP group.This population-based analysis demonstrates that inductionCT is frequently offered to older patients with similar efficacy as in younger patients. However, pre-selection strategies for intensive treatment are insufficient since only half of the older patients subsequently receive their planned ASCT.
Session topic: E-poster
Keyword(s): Elderly, Multiple myeloma, Treatment
Type: Eposter Presentation
Background
The Dutch national clinical guideline recommends bortezomib-based induction chemotherapy (inductionCT) followed by high dose melfalan (HDM) and autologous stem cell transplantation (ASCT) for patients with symptomatic multiple myeloma (symMM) aged ≤65 years. In addition, ASCT should also be considered for patients with symMM aged 66-70 years.
Aims
To evaluate how these recommendations were applied in daily practice in the Netherlands for patients with symMM aged ≤70 years and, secondly, what percentage of patients aged 66-70 years was offered ASCT as their first line treatment.
Methods
From the nationwide population-based Netherlands Cancer Registry, we identified 476 patients aged ≤70 years diagnosed with symMM in 2014 (60% male). Of these patients, 318 (67%) were ≤65 years and 158 (33%) were 66-70 years. InductionCT was defined as bortezomib-based chemotherapy regimens (i.e. BD, PAD, VCD or VTD) with or without (+/-) subsequent HDM and ASCT. Overall response rate (ORR) was defined as achieving complete or partial response i.e. CR, VGPR and PR as best achieved response outcome. Data were analyzed for the total cohort, as well as stratified by age at diagnosis.
Results
Overall, of patients ≤65 years, 283 (89%) were treated with inductionCT, of which VCD was most frequently used (N=231/283;82%), followed by PAD (N=30/283;11%) and BD (N=22/283;8%). The remaining patients received other types of chemotherapeutic regimens (2%) or no chemotherapy at all (9%). Of patients who received inductionCT, 217 of 283 (77%) received the planned HDM+ASCT.Of patients aged 66-70 years, 61 (39%) received inductionCT consisting of either VCD (N=38/61;62%), BD (N=19/61;31%) or PAD (N=4/61;7%). The remaining patients were mostly treated with VMP (N=77/158;49%), while 8% (N=13/158) did not receive any treatment. In contrast to patients aged ≤65 years, only 29 of 61 (48%) patients underwent ASCT after inductionCT.The ORRs were 86% (242/283) and 72% (44/61) for patients ≤65 and 66-70 years who received inductionCT +/- ASCT, respectively. The ORR for patients aged 66-70 years who received VMP was 34% (26/77), which is markedly lower than previously reported in the VISTA trial (ORR, 71%). The ORR for patients who received inductionCT, but did not proceed to ASCT was lower as compared to patients who did proceed to ASCT (51% vs 96%) irrespective of age group. Moreover, the ORR of patients aged 66-70 years who received inductionCT (+/- ASCT) was higher than the ORR of patients in the same age group who received VMP (72% vs 34%).
Conclusion
Our results show that most patients aged ≤65 years start with inductionCT and 77% of these are able to proceed to HDM+ASCT. In addition, among patients aged 66-70 years, 39% start with inductionCT of whom only 48% received subsequent ASCT. Although based on modest patient numbers, the ORR of inductionCT +/- ASCT in patients between 66-70 years was lower as compared to the ORR in the younger patient group, while higher than the ORR in the VMP group.This population-based analysis demonstrates that inductionCT is frequently offered to older patients with similar efficacy as in younger patients. However, pre-selection strategies for intensive treatment are insufficient since only half of the older patients subsequently receive their planned ASCT.
Session topic: E-poster
Keyword(s): Elderly, Multiple myeloma, Treatment
Abstract: E1279
Type: Eposter Presentation
Background
The Dutch national clinical guideline recommends bortezomib-based induction chemotherapy (inductionCT) followed by high dose melfalan (HDM) and autologous stem cell transplantation (ASCT) for patients with symptomatic multiple myeloma (symMM) aged ≤65 years. In addition, ASCT should also be considered for patients with symMM aged 66-70 years.
Aims
To evaluate how these recommendations were applied in daily practice in the Netherlands for patients with symMM aged ≤70 years and, secondly, what percentage of patients aged 66-70 years was offered ASCT as their first line treatment.
Methods
From the nationwide population-based Netherlands Cancer Registry, we identified 476 patients aged ≤70 years diagnosed with symMM in 2014 (60% male). Of these patients, 318 (67%) were ≤65 years and 158 (33%) were 66-70 years. InductionCT was defined as bortezomib-based chemotherapy regimens (i.e. BD, PAD, VCD or VTD) with or without (+/-) subsequent HDM and ASCT. Overall response rate (ORR) was defined as achieving complete or partial response i.e. CR, VGPR and PR as best achieved response outcome. Data were analyzed for the total cohort, as well as stratified by age at diagnosis.
Results
Overall, of patients ≤65 years, 283 (89%) were treated with inductionCT, of which VCD was most frequently used (N=231/283;82%), followed by PAD (N=30/283;11%) and BD (N=22/283;8%). The remaining patients received other types of chemotherapeutic regimens (2%) or no chemotherapy at all (9%). Of patients who received inductionCT, 217 of 283 (77%) received the planned HDM+ASCT.Of patients aged 66-70 years, 61 (39%) received inductionCT consisting of either VCD (N=38/61;62%), BD (N=19/61;31%) or PAD (N=4/61;7%). The remaining patients were mostly treated with VMP (N=77/158;49%), while 8% (N=13/158) did not receive any treatment. In contrast to patients aged ≤65 years, only 29 of 61 (48%) patients underwent ASCT after inductionCT.The ORRs were 86% (242/283) and 72% (44/61) for patients ≤65 and 66-70 years who received inductionCT +/- ASCT, respectively. The ORR for patients aged 66-70 years who received VMP was 34% (26/77), which is markedly lower than previously reported in the VISTA trial (ORR, 71%). The ORR for patients who received inductionCT, but did not proceed to ASCT was lower as compared to patients who did proceed to ASCT (51% vs 96%) irrespective of age group. Moreover, the ORR of patients aged 66-70 years who received inductionCT (+/- ASCT) was higher than the ORR of patients in the same age group who received VMP (72% vs 34%).
Conclusion
Our results show that most patients aged ≤65 years start with inductionCT and 77% of these are able to proceed to HDM+ASCT. In addition, among patients aged 66-70 years, 39% start with inductionCT of whom only 48% received subsequent ASCT. Although based on modest patient numbers, the ORR of inductionCT +/- ASCT in patients between 66-70 years was lower as compared to the ORR in the younger patient group, while higher than the ORR in the VMP group.This population-based analysis demonstrates that inductionCT is frequently offered to older patients with similar efficacy as in younger patients. However, pre-selection strategies for intensive treatment are insufficient since only half of the older patients subsequently receive their planned ASCT.
Session topic: E-poster
Keyword(s): Elderly, Multiple myeloma, Treatment
Type: Eposter Presentation
Background
The Dutch national clinical guideline recommends bortezomib-based induction chemotherapy (inductionCT) followed by high dose melfalan (HDM) and autologous stem cell transplantation (ASCT) for patients with symptomatic multiple myeloma (symMM) aged ≤65 years. In addition, ASCT should also be considered for patients with symMM aged 66-70 years.
Aims
To evaluate how these recommendations were applied in daily practice in the Netherlands for patients with symMM aged ≤70 years and, secondly, what percentage of patients aged 66-70 years was offered ASCT as their first line treatment.
Methods
From the nationwide population-based Netherlands Cancer Registry, we identified 476 patients aged ≤70 years diagnosed with symMM in 2014 (60% male). Of these patients, 318 (67%) were ≤65 years and 158 (33%) were 66-70 years. InductionCT was defined as bortezomib-based chemotherapy regimens (i.e. BD, PAD, VCD or VTD) with or without (+/-) subsequent HDM and ASCT. Overall response rate (ORR) was defined as achieving complete or partial response i.e. CR, VGPR and PR as best achieved response outcome. Data were analyzed for the total cohort, as well as stratified by age at diagnosis.
Results
Overall, of patients ≤65 years, 283 (89%) were treated with inductionCT, of which VCD was most frequently used (N=231/283;82%), followed by PAD (N=30/283;11%) and BD (N=22/283;8%). The remaining patients received other types of chemotherapeutic regimens (2%) or no chemotherapy at all (9%). Of patients who received inductionCT, 217 of 283 (77%) received the planned HDM+ASCT.Of patients aged 66-70 years, 61 (39%) received inductionCT consisting of either VCD (N=38/61;62%), BD (N=19/61;31%) or PAD (N=4/61;7%). The remaining patients were mostly treated with VMP (N=77/158;49%), while 8% (N=13/158) did not receive any treatment. In contrast to patients aged ≤65 years, only 29 of 61 (48%) patients underwent ASCT after inductionCT.The ORRs were 86% (242/283) and 72% (44/61) for patients ≤65 and 66-70 years who received inductionCT +/- ASCT, respectively. The ORR for patients aged 66-70 years who received VMP was 34% (26/77), which is markedly lower than previously reported in the VISTA trial (ORR, 71%). The ORR for patients who received inductionCT, but did not proceed to ASCT was lower as compared to patients who did proceed to ASCT (51% vs 96%) irrespective of age group. Moreover, the ORR of patients aged 66-70 years who received inductionCT (+/- ASCT) was higher than the ORR of patients in the same age group who received VMP (72% vs 34%).
Conclusion
Our results show that most patients aged ≤65 years start with inductionCT and 77% of these are able to proceed to HDM+ASCT. In addition, among patients aged 66-70 years, 39% start with inductionCT of whom only 48% received subsequent ASCT. Although based on modest patient numbers, the ORR of inductionCT +/- ASCT in patients between 66-70 years was lower as compared to the ORR in the younger patient group, while higher than the ORR in the VMP group.This population-based analysis demonstrates that inductionCT is frequently offered to older patients with similar efficacy as in younger patients. However, pre-selection strategies for intensive treatment are insufficient since only half of the older patients subsequently receive their planned ASCT.
Session topic: E-poster
Keyword(s): Elderly, Multiple myeloma, Treatment
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