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Post-Autologous (ASCT) Stem Cell Transplant Therapy in Multiple Myeloma.

Al-Mansour Z, Ramanathan M - Adv Hematol (2014)

Bottom Line: Thalidomide use has been associated with a meaningful improvement in PFS and EFS, however, with substantial side effects.Bortezomib use has been associated with superior outcomes, predominantly in high-risk myeloma patients.Combination regimens utilizing a proteasome inhibitor (i.e., bortezomib) with an immunomodulatory drug (thalidomide or lenalidomide) have provided the best outcomes.

View Article: PubMed Central - PubMed

Affiliation: Division of Hematology/Oncology, School of Medicine, University of Massachusetts, 55 Lake Avenue North, Worcester, MA 01655, USA.

ABSTRACT
Autologous stem cell transplant (ASCT) is the standard of care in transplant-eligible multiple myeloma patients and is associated with significant improvement in progression-free survival (PFS), complete remission rates (CR), and overall survival (OS). However, majority of patients eventually relapse, with a median PFS of around 36 months. Relapses are harder to treat and prognosis declines with each relapse. Achieving and maintaining "best response" to initial therapy is the ultimate goal of first-line treatment and sustained CR is a powerful surrogate for extended survival especially in high-risk multiple myeloma. ASCT is often followed by consolidation/maintenance phase to deepen and/or maintain the response achieved by induction and ASCT. Novel agents like thalidomide, lenalidomide, and bortezomib have been used as single agents or in combination. Thalidomide use has been associated with a meaningful improvement in PFS and EFS, however, with substantial side effects. Data with lenalidomide maintenance after-ASCT is favorable, but the optimal duration of lenalidomide maintenance is still unclear. Bortezomib use has been associated with superior outcomes, predominantly in high-risk myeloma patients. Combination regimens utilizing a proteasome inhibitor (i.e., bortezomib) with an immunomodulatory drug (thalidomide or lenalidomide) have provided the best outcomes. This review article serves as a review of the best available evidence in post-ASCT approaches in multiple myeloma.

No MeSH data available.


Related in: MedlinePlus

Meta-analysis of thalidomide maintenance showing OS benefit (adapted from [15]).
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Related In: Results  -  Collection


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fig3: Meta-analysis of thalidomide maintenance showing OS benefit (adapted from [15]).

Mentions: In their 2012 meta-analysis, IMWG reviewed 6 randomized trials with a total of 2786 patients evaluating thalidomide use after HDC-ASCT in myeloma [46]. Thalidomide maintenance was associated with significant improvement in PFS (HR 0.65; 95% CI 0.59–0.72) and OS (HR 0.84; 95% CI 0.73–0.97); however, there was considerable heterogeneity among individual trials, likely due to variability in inclusion criteria and salvage treatment of choice at disease progression/relapse (see Figures 3 and 4).


Post-Autologous (ASCT) Stem Cell Transplant Therapy in Multiple Myeloma.

Al-Mansour Z, Ramanathan M - Adv Hematol (2014)

Meta-analysis of thalidomide maintenance showing OS benefit (adapted from [15]).
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4265378&req=5

fig3: Meta-analysis of thalidomide maintenance showing OS benefit (adapted from [15]).
Mentions: In their 2012 meta-analysis, IMWG reviewed 6 randomized trials with a total of 2786 patients evaluating thalidomide use after HDC-ASCT in myeloma [46]. Thalidomide maintenance was associated with significant improvement in PFS (HR 0.65; 95% CI 0.59–0.72) and OS (HR 0.84; 95% CI 0.73–0.97); however, there was considerable heterogeneity among individual trials, likely due to variability in inclusion criteria and salvage treatment of choice at disease progression/relapse (see Figures 3 and 4).

Bottom Line: Thalidomide use has been associated with a meaningful improvement in PFS and EFS, however, with substantial side effects.Bortezomib use has been associated with superior outcomes, predominantly in high-risk myeloma patients.Combination regimens utilizing a proteasome inhibitor (i.e., bortezomib) with an immunomodulatory drug (thalidomide or lenalidomide) have provided the best outcomes.

View Article: PubMed Central - PubMed

Affiliation: Division of Hematology/Oncology, School of Medicine, University of Massachusetts, 55 Lake Avenue North, Worcester, MA 01655, USA.

ABSTRACT
Autologous stem cell transplant (ASCT) is the standard of care in transplant-eligible multiple myeloma patients and is associated with significant improvement in progression-free survival (PFS), complete remission rates (CR), and overall survival (OS). However, majority of patients eventually relapse, with a median PFS of around 36 months. Relapses are harder to treat and prognosis declines with each relapse. Achieving and maintaining "best response" to initial therapy is the ultimate goal of first-line treatment and sustained CR is a powerful surrogate for extended survival especially in high-risk multiple myeloma. ASCT is often followed by consolidation/maintenance phase to deepen and/or maintain the response achieved by induction and ASCT. Novel agents like thalidomide, lenalidomide, and bortezomib have been used as single agents or in combination. Thalidomide use has been associated with a meaningful improvement in PFS and EFS, however, with substantial side effects. Data with lenalidomide maintenance after-ASCT is favorable, but the optimal duration of lenalidomide maintenance is still unclear. Bortezomib use has been associated with superior outcomes, predominantly in high-risk myeloma patients. Combination regimens utilizing a proteasome inhibitor (i.e., bortezomib) with an immunomodulatory drug (thalidomide or lenalidomide) have provided the best outcomes. This review article serves as a review of the best available evidence in post-ASCT approaches in multiple myeloma.

No MeSH data available.


Related in: MedlinePlus