SUCCESFULL AUTOLOGOUS STEM CELL TRANSPLANTATION AFTER VELCADE-BASED.... EHA Library. Martinez-Robles V. May 18 2017; 182895

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SUCCESFULL AUTOLOGOUS STEM CELL TRANSPLANTATION AFTER VELCADE-BASED REFRACTORY MULTIPLE MYELOMA PATIENTS

Author(s):

Violeta Martínez-Robles

Belén Ballina

Seila Cerdá

Natalia de las Heras

José Antonio Rodríguez-García

Fernando Escalante

(Abstract release date: 05/18/17) EHA Library. Martinez-Robles V. 05/18/17; 182895; PB2182

Dr. Violeta Martinez-Robles
Contributions

PDF Abstract

Abstract

Abstract: PB2182

Type: Publication Only

Background
The optimal induction treatment for Newly Diagnosed Multiple Myeloma Patients needs combinations with Bortezomib-Based (Bor-Based) schemes.

Primary Refractory patients include patients with progressive disease or rapid (<60 d) relapse after these optimal induction approach have a very bad prognosis.

Lenalidomide-Dexamethasone (LenDex) were usually the next step in the treament of these patients, until the recent introduction of triplets combination LenDex-based.

Autologous Stem Cell Transplantation (ASCT) have proven efficacy in NDMM younger patients that have got at least a partial response (PR) after the induction therapy.

There are few data about toxicity and response of ASCT in primary refractory patient that can obtain a response with LenDex rescue treatment.

Aims
Analysis of tolerance, response and overall survival of ASCT-candidates that are primary refractory to Bor-Based induction treatment.

Methods
Retrospective analysis of our database.

From 2010 to Nov-2016, 53 ASCT-Candidates (for 1st or 2nd ASCT procedures) were included. Median Age for diagnosis was 62 (46-71). Median Age for ASCT procedure was 63 (46-72).

12 of these 53 patients (22.6%) were considered primary refractory and considered candidates to get Len-Based rescue treatment. 6 of them (50%) were woman.

Characteristics of Disease: IgG kappa (4), IgG-lambda (3), IgA kappa (3), IgA lambda (1), Light Chain lambda (1). ISS I/II/III): 5/2/5.

Induction treatment: VelDex (4), VTD (6), VCD (2). Median of cycles administered: 6 (2-8). Best Response to induction treatment: >PR (6), Minimal Response (1), progressive disease (5)

Len-Based (12). Plus CFM in 3 of them to optimize response. Median number of cycles administered: 6 (3-12). 3 of them didn´t responde. Of the other 9, 6 of them were considered candidate to intensificate treatment with high doses chemotherapy supported with an ASCT (2 of 6 to a 2nd ASCT procedure). The other 3 patients are in treatment or in preASCT evaluation.

Characteristics of the after-rescue ASCT-patients. Median age at ASCT: 62 (49-70). All of them received Melphalan 200 mg/m2 as conditioning treatment.

Results
Morbidity or mortality (M&M) (0%) of ASCT procedure in refractory patients is similar to non-refractory patients.

After a median follow up of 46 months from diagnosis for all ASCT-candidates group, the refractory patients get an overall survival of 46.2 months (3-72 m). Any of them have relapsed yet. 2 of them are in biological relapse without need of treatment.

Conclusion
Patients refractoriness to induction may receive ASCT after a rescue treatment LenDex based, as is effective in this group conventionally considered to have a very bad outcome.

New combinations (triplet) with new drugs with LenDex-based treatment may improve the responses rates and overall survival before and after of ASCT procedure in these group.

Session topic: 22. Stem cell transplantation - Clinical

Keyword(s): Refractory, Multiple Myeloma