Myeloma ASH 2010 highlights

Abstract

the questions and for the sake of clarity they have been discussed together. These results should be examined in the context of the current approaches for managing myeloma. Broadly, the treatment strategy for myeloma consists of an ‘‘induction therapy’’ aimed at rapid control of the disease followed by a consolidation strategy that may include stem cell transplant (SCT), followed by maintenance strategies where appropriate [2]. This should be complemented by full supportive care to ameliorate the effect of myeloma-related end organ damage and other potential complications. We present some of the most exciting findings form the meeting, grouping them in the context of treatment steps for better perspective of their impact on daily practice. Initial Therapy of Myeloma The results from several Phase 2 and Phase 3 trials were presented looking at the efficacy of different combinations in previously untreated patients. In general, the different trials examined two, three, and four drug combinations that included both new and old drugs. Cavo et al. presented the results of a randomized trial that compared bortezomib, thalidomide and dexamethasone with thalidomide and dexamethasone as initial therapy of newly diagnosed MM followed by double autologous stem cell transplantation and further consolidation therapy [3]. Initial treatment consisted of three 21-day cycles of thalidomide (100–200 mg/day) along with dexamethasone (320 mg/cycle) with (TD) or without bortezomib 1.3 mg/m 2 twice weekly (VTD). Patients then had stem cells collected with cyclophosphamide and growth factors, followed by tandem ASCT with Mel 200 conditioning. Patients received thalidomide and dexamethasone between the ASCT and then received three 5-week cycles of thalidomide and dexamethasone with or without bortezomib 1.3 mg/m 2 weekly. Overall, 236 patients were randomized to VTD and 238 to the TD arm. There was a progressive increase in the depth of response during each phase of therapy with nCR or better rates of 31%, 52%, 55%, and 62% after induction, 1st ASCT, 2nd ASCT, and consolidation respectively with VTD; all of which was significantly better than TD (11%, 31%, 41%, and 45%, respectively). Addition of bortezomib to TD resulted in a 39% relative reduction in the risk of progression with no difference in the overall survival after a median follow-up duration of 36 months. Subgroup analysis showed that the impact of t(4;14) on progression free survival (PFS) was not evident among patients getting bortezomib, unlike TD suggesting a beneficial effect of the drug on patients with this high-risk