Contributions
Abstract: PB2202
Type: Publication Only
Background
In the last decade numerous studies have shown that proteasome inhibitors and immunomodulatory drugs lead to notable advancements over conventional chemotherapy in multiple myeloma patients. Indeed, a 3-drug regimen with these novel agents is the best induction treatment for young newly diagnosed multiple myeloma (YNDMM) patients before autologous stem cell transplantation (ASCT).
Aims
To compare the data reported in the literature with the “real-life” clinical practice at a single Center. We report our experience over the last 25 years comparing the efficacy of old drugs vs novel agents. In addition, the responses obtained with a single vs double ASCT in this cohort of patients were also evaluated.
Methods
We retrospectively analyzed 258 YNDMM patients treated at our Center between October 1988 and November 2014. All patients received old or novel agents as induction treatment, followed by stem cell mobilization with high-dose cyclophosphamide plus filgrastim and conditioning chemotherapy with melphalan at 200 mg/m2. Tandem ASCT was performed sequentially 3-6 months after the first transplant. The primary endpoint was overall survival (OS) and the secondary end point progression-free survival (PFS).
Results
Between October 1988 and October 2008, 173/258 patients received as induction treatment old drugs, i.e. VAD-vincristine, doxorubicin and dexamethasone (n=167) or MP- melphalan and prednisone (n=6), while, between February 2005 and November 2013, 85/258 patients were treated with novel agents, i.e. bortezomib-based (n=67) or IMiD-based regimens (n=18). All 258 patients received high-dose melphalan and a single (n=153) or tandem (n=105) ASCT.
Patients treated with old drugs obtained a CR/nCR/VGPR in 17.9% of cases after induction, in 28.9% after a single ASCT and in 34.5% after a tandem ASCT. Patients treated with new drugs obtained a CR/nCR/VGPR in 42.3% of cases after induction, in 42.3% after a single ASCT and in 54% after a tandem ASCT. The contribution of the second ASCT was statistically significant for patients treated with both old and new drugs (p = 0.005 vs p = 0.001).
Patients in CR/nCR/VGPR after induction showed a better OS and PFS at 10 years (62.1% vs 40.7%; p = 0.0632 and 36.2% vs 17.2%; p = 0.0685).
Patients treated with new drugs had a slightly better OS than patients treated with old drugs (66.1% vs 51.5%, p = 0.26) and a significantly better PFS (55% vs 25.3%, p = 0.0047).
Among our 258 patients, 144 presented a first relapse. They had been treated as follows:1) 51 patients (35.4%) received old agents as first and second line therapy; 2) 79 patients old agents for first line therapy and novel agents for second line therapy (54.9%); 3) 2 patients novel agents for first line therapy and old agents for second line therapy (1.4%); 4) 12 patients novel agents both as first and second line treatment (8.3%). Our analysis focused on groups 1 and 2. OS and PFS at 10 years were better for patients of group 2 (20.4 vs 2.4%; p <0.0001 and 10% vs 2.3%; p = 0.02). PFS2 (the interval from treatment start at the onset to the second relapse) at 10 years was also significantly better for group 2 (25.7% vs 9.2%; p = 0.0002).
Conclusion
Our real-life experience confirms that novel agents have replaced the old drugs as induction treatment prior to ASCT in YNDMM patients. Moreover, according to our results, tandem ASCT still maintains an important role even in the era of novel agents. Novel agents have also a significant impact in the subsequent lines of treatments.
Session topic: 14. Myeloma and other monoclonal gammopathies - Clinical
Keyword(s): Autologous hematopoietic stem cell transplantation, chemotherapy, Imids, Proteasome inhibitor
Abstract: PB2202
Type: Publication Only
Background
In the last decade numerous studies have shown that proteasome inhibitors and immunomodulatory drugs lead to notable advancements over conventional chemotherapy in multiple myeloma patients. Indeed, a 3-drug regimen with these novel agents is the best induction treatment for young newly diagnosed multiple myeloma (YNDMM) patients before autologous stem cell transplantation (ASCT).
Aims
To compare the data reported in the literature with the “real-life” clinical practice at a single Center. We report our experience over the last 25 years comparing the efficacy of old drugs vs novel agents. In addition, the responses obtained with a single vs double ASCT in this cohort of patients were also evaluated.
Methods
We retrospectively analyzed 258 YNDMM patients treated at our Center between October 1988 and November 2014. All patients received old or novel agents as induction treatment, followed by stem cell mobilization with high-dose cyclophosphamide plus filgrastim and conditioning chemotherapy with melphalan at 200 mg/m2. Tandem ASCT was performed sequentially 3-6 months after the first transplant. The primary endpoint was overall survival (OS) and the secondary end point progression-free survival (PFS).
Results
Between October 1988 and October 2008, 173/258 patients received as induction treatment old drugs, i.e. VAD-vincristine, doxorubicin and dexamethasone (n=167) or MP- melphalan and prednisone (n=6), while, between February 2005 and November 2013, 85/258 patients were treated with novel agents, i.e. bortezomib-based (n=67) or IMiD-based regimens (n=18). All 258 patients received high-dose melphalan and a single (n=153) or tandem (n=105) ASCT.
Patients treated with old drugs obtained a CR/nCR/VGPR in 17.9% of cases after induction, in 28.9% after a single ASCT and in 34.5% after a tandem ASCT. Patients treated with new drugs obtained a CR/nCR/VGPR in 42.3% of cases after induction, in 42.3% after a single ASCT and in 54% after a tandem ASCT. The contribution of the second ASCT was statistically significant for patients treated with both old and new drugs (p = 0.005 vs p = 0.001).
Patients in CR/nCR/VGPR after induction showed a better OS and PFS at 10 years (62.1% vs 40.7%; p = 0.0632 and 36.2% vs 17.2%; p = 0.0685).
Patients treated with new drugs had a slightly better OS than patients treated with old drugs (66.1% vs 51.5%, p = 0.26) and a significantly better PFS (55% vs 25.3%, p = 0.0047).
Among our 258 patients, 144 presented a first relapse. They had been treated as follows:1) 51 patients (35.4%) received old agents as first and second line therapy; 2) 79 patients old agents for first line therapy and novel agents for second line therapy (54.9%); 3) 2 patients novel agents for first line therapy and old agents for second line therapy (1.4%); 4) 12 patients novel agents both as first and second line treatment (8.3%). Our analysis focused on groups 1 and 2. OS and PFS at 10 years were better for patients of group 2 (20.4 vs 2.4%; p <0.0001 and 10% vs 2.3%; p = 0.02). PFS2 (the interval from treatment start at the onset to the second relapse) at 10 years was also significantly better for group 2 (25.7% vs 9.2%; p = 0.0002).
Conclusion
Our real-life experience confirms that novel agents have replaced the old drugs as induction treatment prior to ASCT in YNDMM patients. Moreover, according to our results, tandem ASCT still maintains an important role even in the era of novel agents. Novel agents have also a significant impact in the subsequent lines of treatments.
Session topic: 14. Myeloma and other monoclonal gammopathies - Clinical
Keyword(s): Autologous hematopoietic stem cell transplantation, chemotherapy, Imids, Proteasome inhibitor