Abstract
We retrospectively reviewed all patients (n = 243) receiving bortezomib, lenalidomide, and dexamethasone (VRd) induction followed by autologous stem cell transplantation (ASCT) for multiple myeloma at the Mayo Clinic between January 2010 and April of 2017. Median age was 61 (interquartile range, 55–67) with 62% of patients being male. High-risk cytogenetic abnormalities (HRA) were present in 34% of patients. A total of 166 (68%) patients received some form of maintenance/other therapy post transplant (no maintenance (NM, n = 77), lenalidomide maintenance (LM, n = 108), bortezomib maintenance (BM, n = 39), and other therapy (OT, n = 19)). Overall response rate at day 100 post ASCT was 99% (CR 42%) with CR rate increasing to 62% at time of best response post transplant. Two year and 5 year overall survival rates were 90% and 67%, respectively, with an estimated median overall survival (OS) and progression-free survival (PFS) of 96 and 28 months, respectively. HRA was associated with a worse OS but not PFS (median OS: not reached for standard risk vs 60 months for HRA, P = 0.0006; median PFS: 27 months for standard risk vs 22 months for HRA, P = 0.70). The combination of VRd followed by ASCT is a highly effective regimen producing deep and durable responses in many patients.
Highlights
There has been considerable progress in therapy for multiple myeloma in recent years
We conducted a retrospective review of all patients seen at Mayo Clinic Rochester that received induction with bortezomib, lenalidomide and dexamethasone followed by autologous stem cell transplantation for multiple myeloma, between 1st January 2010 and 30th of April 2017
Response at day 100 was determined by assessing individual patient data of serum and urine protein electrophoresis, immunofixation, serum-free light chain assay, and bone marrow (BM) aspiration and biopsy obtained at ~100 days post Autologous stem cell transplantation (ASCT)
Summary
There has been considerable progress in therapy for multiple myeloma in recent years. Autologous stem cell transplantation (ASCT) has been standard therapy for multiple myeloma for over two decades with clinical trials showing an improvement in overall survival[3]. This is Sidiqi et al Blood Cancer Journal (2018)8:106 Variable. Median (IQR), years Male, n (%) ISS Stage I Stage II Stage III Missing FISH cytogenetics, n (%) High risk Deletion(17p) t(4;14) t(14;16) Missing Time to transplant ≤6 months >6 months Conditioning n (%) Melphalan 200 mg/m2 Melphalan 140 mg/m2 Carfilzomib/melphalan Bortezomib/TBI/melphalan BEAM. IQR interquartile range, ISS international staging system, FISH fluorescent in situ hybridization, TBI total body irradiation, BEAM carmustine, etoposide, cytarabine, and melphalan transplant as upfront therapy for multiple myeloma at the Mayo Clinic
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