RETROSPECTIVE COHORT ANALYSIS EXAMINING THE EFFICACY AND SAFETY OF (V)DTPACE IN NEWLY DIAGNOSED AND RELAPSED/REFRACTORY MYELOMA PATIENTS ? THE UK EXPERIENCE
(Abstract release date: 05/19/16)
EHA Library. Sriskandarajah P. 06/09/16; 134858; PB1958
Dr. Priya Sriskandarajah
Contributions
Contributions
Abstract
Abstract: PB1958
Type: Publication Only
Background
Multiple myeloma remains incurable in spite of advances in treatment. In the UK, the combination of dexamethasone, thalidomide, cisplatin, doxorubicin, cyclophosphamide and etoposide (DTPACE) continues to play a role in patients with relapsed/refractory multiple myeloma (RRMM), either as a bridge to stem cell transplant, or for rapid tumor debulking. Recently, bortezomib has also been included (VDTPACE) - this combination was introduced by the Arkansas group in the Total Therapy 3 (TT3) study, where MM patients received this as induction prior to tandem autologous stem cell transplant (ASCT), resulting in enhanced response rates and prolonged survival.However, due to the intensity of both VDTPACE and DTPACE, these regimes have not been adopted by many centers and results outside the Arkansas group have therefore been rarely reported.At the Royal Marsden Hospital (RMH) we have used (V)DTPACE in selected cases where standard therapies are deemed inadequate, including newly diagnosed patients with specific high risk features, salvage treatment for those who were primary refractory and in patients with RR disease.
Aims
To assess response rates, impact on stem cell harvest and tolerability in myeloma patients treated with (V)DTPACE at RMH.
Methods
We retrospectively reviewed the medical notes for all myeloma patients treated with (V)DTPACE at RMH between 2010 and 2015. Our primary objective was ORR defined as PR or better. Secondary objectives included number of stem cells harvested (if applicable) and toxicities (as per CTCAE v4.0 criteria). Patient demographics including age, gender and prior treatment exposure were also analyzed.
Results
Between 2010 and 2015, 53 patients received DTPACE and 26 received VDTPACE. The median age was 55 years with a male predominance (61%). 7/79 (9%) patients received treatment upfront due to high-risk disease features, including 2 patients with plasma cell leukemia and 2 with extensive extramedullary disease at presentation. 8/79 (10%) were primary refractory (6/kg. The ORR (≥PR) observed following DTPACE was 100% (20% CR) in newly diagnosed, 100% in primary salvage and 51% (13% CR) in RR patients. Following VDTPACE, ORR was 100%, 71% and 82% (6% CR) respectively.Commonly reported toxicities included Grade 3≥ neutropenia (94%) and Grade 3≥ thrombocytopenia (48%). No thrombo-embolic events or grade 3≥ neuropathy were reported.At analysis, 39/79 (49%) patients were alive. There were no treatment-related deaths. Survival data is currently analysed and will be presented at meeting.
Conclusion
Our results demonstrate the efficacy of VDTPACE in newly diagnosed and relapsed/refractory patients, in spite of prior exposure to thalidomide or bortezomib. Importantly this regimen can safely be used to salvage patients with an insufficient response to conventional first-line therapy. VDTPACE had no impact on stem cell mobilization, and was well tolerated with no treatment-related deaths reported.
Session topic: E-poster
Keyword(s): Multiple myeloma, Salvage chemotherapy, Transplant
Type: Publication Only
Background
Multiple myeloma remains incurable in spite of advances in treatment. In the UK, the combination of dexamethasone, thalidomide, cisplatin, doxorubicin, cyclophosphamide and etoposide (DTPACE) continues to play a role in patients with relapsed/refractory multiple myeloma (RRMM), either as a bridge to stem cell transplant, or for rapid tumor debulking. Recently, bortezomib has also been included (VDTPACE) - this combination was introduced by the Arkansas group in the Total Therapy 3 (TT3) study, where MM patients received this as induction prior to tandem autologous stem cell transplant (ASCT), resulting in enhanced response rates and prolonged survival.However, due to the intensity of both VDTPACE and DTPACE, these regimes have not been adopted by many centers and results outside the Arkansas group have therefore been rarely reported.At the Royal Marsden Hospital (RMH) we have used (V)DTPACE in selected cases where standard therapies are deemed inadequate, including newly diagnosed patients with specific high risk features, salvage treatment for those who were primary refractory and in patients with RR disease.
Aims
To assess response rates, impact on stem cell harvest and tolerability in myeloma patients treated with (V)DTPACE at RMH.
Methods
We retrospectively reviewed the medical notes for all myeloma patients treated with (V)DTPACE at RMH between 2010 and 2015. Our primary objective was ORR defined as PR or better. Secondary objectives included number of stem cells harvested (if applicable) and toxicities (as per CTCAE v4.0 criteria). Patient demographics including age, gender and prior treatment exposure were also analyzed.
Results
Between 2010 and 2015, 53 patients received DTPACE and 26 received VDTPACE. The median age was 55 years with a male predominance (61%). 7/79 (9%) patients received treatment upfront due to high-risk disease features, including 2 patients with plasma cell leukemia and 2 with extensive extramedullary disease at presentation. 8/79 (10%) were primary refractory (
Conclusion
Our results demonstrate the efficacy of VDTPACE in newly diagnosed and relapsed/refractory patients, in spite of prior exposure to thalidomide or bortezomib. Importantly this regimen can safely be used to salvage patients with an insufficient response to conventional first-line therapy. VDTPACE had no impact on stem cell mobilization, and was well tolerated with no treatment-related deaths reported.
Session topic: E-poster
Keyword(s): Multiple myeloma, Salvage chemotherapy, Transplant
Abstract: PB1958
Type: Publication Only
Background
Multiple myeloma remains incurable in spite of advances in treatment. In the UK, the combination of dexamethasone, thalidomide, cisplatin, doxorubicin, cyclophosphamide and etoposide (DTPACE) continues to play a role in patients with relapsed/refractory multiple myeloma (RRMM), either as a bridge to stem cell transplant, or for rapid tumor debulking. Recently, bortezomib has also been included (VDTPACE) - this combination was introduced by the Arkansas group in the Total Therapy 3 (TT3) study, where MM patients received this as induction prior to tandem autologous stem cell transplant (ASCT), resulting in enhanced response rates and prolonged survival.However, due to the intensity of both VDTPACE and DTPACE, these regimes have not been adopted by many centers and results outside the Arkansas group have therefore been rarely reported.At the Royal Marsden Hospital (RMH) we have used (V)DTPACE in selected cases where standard therapies are deemed inadequate, including newly diagnosed patients with specific high risk features, salvage treatment for those who were primary refractory and in patients with RR disease.
Aims
To assess response rates, impact on stem cell harvest and tolerability in myeloma patients treated with (V)DTPACE at RMH.
Methods
We retrospectively reviewed the medical notes for all myeloma patients treated with (V)DTPACE at RMH between 2010 and 2015. Our primary objective was ORR defined as PR or better. Secondary objectives included number of stem cells harvested (if applicable) and toxicities (as per CTCAE v4.0 criteria). Patient demographics including age, gender and prior treatment exposure were also analyzed.
Results
Between 2010 and 2015, 53 patients received DTPACE and 26 received VDTPACE. The median age was 55 years with a male predominance (61%). 7/79 (9%) patients received treatment upfront due to high-risk disease features, including 2 patients with plasma cell leukemia and 2 with extensive extramedullary disease at presentation. 8/79 (10%) were primary refractory (6/kg. The ORR (≥PR) observed following DTPACE was 100% (20% CR) in newly diagnosed, 100% in primary salvage and 51% (13% CR) in RR patients. Following VDTPACE, ORR was 100%, 71% and 82% (6% CR) respectively.Commonly reported toxicities included Grade 3≥ neutropenia (94%) and Grade 3≥ thrombocytopenia (48%). No thrombo-embolic events or grade 3≥ neuropathy were reported.At analysis, 39/79 (49%) patients were alive. There were no treatment-related deaths. Survival data is currently analysed and will be presented at meeting.
Conclusion
Our results demonstrate the efficacy of VDTPACE in newly diagnosed and relapsed/refractory patients, in spite of prior exposure to thalidomide or bortezomib. Importantly this regimen can safely be used to salvage patients with an insufficient response to conventional first-line therapy. VDTPACE had no impact on stem cell mobilization, and was well tolerated with no treatment-related deaths reported.
Session topic: E-poster
Keyword(s): Multiple myeloma, Salvage chemotherapy, Transplant
Type: Publication Only
Background
Multiple myeloma remains incurable in spite of advances in treatment. In the UK, the combination of dexamethasone, thalidomide, cisplatin, doxorubicin, cyclophosphamide and etoposide (DTPACE) continues to play a role in patients with relapsed/refractory multiple myeloma (RRMM), either as a bridge to stem cell transplant, or for rapid tumor debulking. Recently, bortezomib has also been included (VDTPACE) - this combination was introduced by the Arkansas group in the Total Therapy 3 (TT3) study, where MM patients received this as induction prior to tandem autologous stem cell transplant (ASCT), resulting in enhanced response rates and prolonged survival.However, due to the intensity of both VDTPACE and DTPACE, these regimes have not been adopted by many centers and results outside the Arkansas group have therefore been rarely reported.At the Royal Marsden Hospital (RMH) we have used (V)DTPACE in selected cases where standard therapies are deemed inadequate, including newly diagnosed patients with specific high risk features, salvage treatment for those who were primary refractory and in patients with RR disease.
Aims
To assess response rates, impact on stem cell harvest and tolerability in myeloma patients treated with (V)DTPACE at RMH.
Methods
We retrospectively reviewed the medical notes for all myeloma patients treated with (V)DTPACE at RMH between 2010 and 2015. Our primary objective was ORR defined as PR or better. Secondary objectives included number of stem cells harvested (if applicable) and toxicities (as per CTCAE v4.0 criteria). Patient demographics including age, gender and prior treatment exposure were also analyzed.
Results
Between 2010 and 2015, 53 patients received DTPACE and 26 received VDTPACE. The median age was 55 years with a male predominance (61%). 7/79 (9%) patients received treatment upfront due to high-risk disease features, including 2 patients with plasma cell leukemia and 2 with extensive extramedullary disease at presentation. 8/79 (10%) were primary refractory (
Conclusion
Our results demonstrate the efficacy of VDTPACE in newly diagnosed and relapsed/refractory patients, in spite of prior exposure to thalidomide or bortezomib. Importantly this regimen can safely be used to salvage patients with an insufficient response to conventional first-line therapy. VDTPACE had no impact on stem cell mobilization, and was well tolerated with no treatment-related deaths reported.
Session topic: E-poster
Keyword(s): Multiple myeloma, Salvage chemotherapy, Transplant
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