RVD induction and autologous stem cell transplantation followed by lenalidomide maintenance in newly diagnosed multiple myeloma: a phase 2 study of the Finnish Myeloma Group.

Autor: Luoma S; Comprehensive Cancer Center, Department of Hematology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland. sini.luoma@hus.fi., Anttila P; Comprehensive Cancer Center, Department of Hematology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland., Säily M; Hematology-Oncology Unit, Oulu University Hospital, Oulu, Finland., Lundan T; Department of Clinical Chemistry and TYKSLAB, University of Turku and Turku University Hospital, Turku, Finland., Heiskanen J; Comprehensive Cancer Center, Department of Hematology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland., Siitonen T; Hematology-Oncology Unit, Oulu University Hospital, Oulu, Finland., Kakko S; Hematology-Oncology Unit, Oulu University Hospital, Oulu, Finland., Putkonen M; Hematology Unit, Turku University Hospital, Turku, Finland., Ollikainen H; Department of Medicine, Satakunta Central Hospital, Pori, Finland., Terävä V; Hematology Unit, Tampere University Hospital, Tampere, Finland., Sankelo M; Hematology Unit, Tampere University Hospital, Tampere, Finland., Partanen A; Department of Medicine, Kuopio University Hospital, Kuopio, Finland.; Department of Medicine, Mikkeli Central Hospital, Mikkeli, Finland., Launonen K; Hematology-Oncology Unit, Oulu University Hospital, Oulu, Finland.; Department of Medicine, Länsi-Pohja Central Hospital, Kemi, Finland., Räsänen A; Department of Medicine, Kymenlaakso Central Hospital, Kotka, Finland., Sikiö A; Department of Medicine, Central Finland Central Hospital, Jyväskylä, Finland., Suominen M; Department of Medicine, Kanta-Häme Central Hospital, Hämeenlinna, Finland., Bazia P; Department of Medicine, Kainuu Central Hospital, Kajaani, Finland., Kananen K; Department of Medicine, Kainuu Central Hospital, Kajaani, Finland., Lievonen J; Comprehensive Cancer Center, Department of Hematology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland., Selander T; Science Service Center, Kuopio University Hospital, Kuopio, Finland., Pelliniemi TT; Fimlab Laboratories Ltd., Tampere, Finland., Ilveskero S; HUSLAB Helsinki University Hospital, Helsinki, Finland., Huotari V; Fimlab Laboratories Ltd., Tampere, Finland.; NordLab Oulu, Oulu University Hospital, Oulu, Finland., Mäntymaa P; Laboratory of Eastern Finland, Kuopio University Hospital, Kuopio, Finland., Tienhaara A; Department of Clinical Chemistry and TYKSLAB, University of Turku and Turku University Hospital, Turku, Finland., Jantunen E; Department of Medicine, Kuopio University Hospital, Kuopio, Finland.; Institute of Clinical Medicine/Internal Medicine, University of Eastern Finland, Kuopio, Finland.; Department of Medicine, North Carelia Hospital District, Joensuu, Finland., Silvennoinen R; Comprehensive Cancer Center, Department of Hematology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.; Department of Medicine, Kuopio University Hospital, Kuopio, Finland.
Jazyk: angličtina
Zdroj: Annals of hematology [Ann Hematol] 2019 Dec; Vol. 98 (12), pp. 2781-2792. Date of Electronic Publication: 2019 Oct 31.
DOI: 10.1007/s00277-019-03815-7
Abstrakt: Autologous stem cell transplantation (ASCT) combined with novel agents is the standard treatment for transplant-eligible, newly diagnosed myeloma (NDMM) patients. Lenalidomide is approved for maintenance after ASCT until progression, although the optimal duration of maintenance is unknown. In this trial, 80 patients with NDMM received three cycles of lenalidomide, bortezomib, and dexamethasone followed by ASCT and lenalidomide maintenance until progression or toxicity. The primary endpoint was the proportion of flow-negative patients. Molecular response was assessed if patients were flow-negative or in stringent complete response (sCR). By intention to treat, the overall response rate was 89%. Neither median progression-free survival nor overall survival (OS) has been reached. The OS at 3 years was 83%. Flow-negativity was reached in 53% and PCR-negativity in 28% of the patients. With a median follow-up of 27 months, 29 (36%) patients are still on lenalidomide and 66% of them have sustained flow-negativity. Lenalidomide maintenance phase was reached in 8/16 high-risk patients but seven of them have progressed after a median of only 6 months. In low- or standard-risk patients, the outcome was promising, but high-risk patients need more effective treatment approach. Flow-negativity with the conventional flow was an independent predictor for longer PFS.
Databáze: MEDLINE
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