Autotransplant with and without induction chemotherapy in older multiple myeloma patients
| Autor: | Orhan Sezer, Christian Gerecke, Hans-Heinrich Wolf, Christian Langer, Ralf Schmidmaier, Marcus Hentrich, Bernd Hertenstein, Brigitte Schnabel, Wolfram Jung, Tobias Dechow, Ralf Bargou, Sigrid Adler-Reichel, Holger Hebart, Albrecht Reichle, Martin Gramatzki, Michael Pfreundschuh, Bertold Emmerich, Norbert Frickhofen, Else Heidemann, Hannes Wandt, Axel Hinke, Hermann Einsele, Peter Liebisch, Nicola Lang, Burkhard Hennemann, Tim Hendrik Bruemmendorf, Martin Bentz, Christian Straka, Lorenz Trümper, Hans Salwender, Bernd Metzner, Kerstin Schäfer-Eckart, Andreas Sandermann, Stefan Knop, Helga Bernhard |
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| Jazyk: | angličtina |
| Rok vydání: | 2016 |
| Předmět: |
Male
Mucositis Melphalan medicine.medical_specialty 600 Technik Medizin angewandte Wissenschaften::610 Medizin und Gesundheit Transplantation Autologous Disease-Free Survival Article Cytogenetics 03 medical and health sciences 0302 clinical medicine Humans Medicine Autologous transplantation Multiple myeloma Aged Lenalidomide business.industry Hazard ratio Induction chemotherapy Induction Chemotherapy Hematology Middle Aged medicine.disease Hematopoietic Stem Cell Mobilization Surgery Transplantation Treatment Outcome 030220 oncology & carcinogenesis Female Multiple Myeloma business Stem Cell Transplantation 030215 immunology medicine.drug |
| DOI: | 10.3324/haematol.2016.151860 |
| Popis: | Autologous transplantation is controversial for older patients with multiple myeloma. The role of age-adjusted high-dose melphalan and the impact of preceeding induction chemotherapy cycles has been unclear. A total of 434 patients 60 to 70 years of age were randomly assigned to 4 cycles of standard anthracycline-based induction chemotherapy or no induction cycles. For all patients, double autologous transplantation after melphalan 140 mg/m2 (MEL140) was planned. The primary end point was progression-free survival. Of 420 eligible patients, 85% received a first transplant and 69% completed double transplantation. Treatment duration was short with a median of 7.7 months with induction chemotherapy cycles and 4.6 months without it. On the intention-to-treat basis, median progression-free survival with induction chemotherapy cycles (207 patients) was 21.4 months versus 20.0 months with no induction cycles (213 patients) (hazard ratio 1.04, 95% confidence interval [CI] 0.84 to 1.28; P=0.36). Per protocol the progression-free survival was 23.7 months versus 23.0 months (p=0.28). For patients with age ≥ 65 years (55%) the outcome was not inferior. Patients with low-risk cytogenetics (absence of del17p13, t(4;14) and 1q21 gains) showed a favorable overall survival and included the patients with sustained first remission. MEL140 was associated with a low rate of severe mucositis (10%) and treatment-related deaths (1%). Based on the hazard ratio, the short treatment trunk consisting of mobilization chemotherapy and tandem MEL140 with autologous transplantation achieved 96% of the progression-free survival, demonstrating value as an independent component of myeloma therapy in older patients with multiple myeloma regarded fit for autologous transplantation (NCT 02288741). |
| Databáze: | OpenAIRE |
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