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Bortezomib, thalidomide, and dexamethasone as induction therapy for patients with symptomatic multiple myeloma: a retrospective study.
Cancer. 2010 Jul 01; 116(13):3143-51.C

Abstract

BACKGROUND

This single-center retrospective study determined the efficacy of bortezomib, thalidomide, and dexamethasone (BTD) as induction for patients with multiple myeloma (MM) who were eligible for autologous stem cell transplantation (ASCT).

METHODS

Patients with symptomatic MM who had received BTD induction before stem cell collection at Winship Cancer Institute were included. BTD induction comprised up to 8 3-week cycles of bortezomib 1.3 mg/m(2) on Days 1, 4, 8, and 11; thalidomide 100 mg daily; and dexamethasone 40 mg on Days 1 through 4 and Days 9 through 12. Stem cell mobilization involved granulocyte-colony-stimulating factor and/or cyclophosphamide. Response was assessed according to European Group for Blood and Marrow Transplantation criteria.

RESULTS

Review of medical records identified 44 eligible patients (34 patients who were treated in the front-line setting and 10 patients who were treated for recurrent disease) who received a median of 4 BTD cycles. The overall response rate (ORR) was 91%, which included a greater than or equal to very good partial response (> or = VGPR) rate of 57% (including 20% stringent complete responses/complete response [sCR/CR] rate). In front-line patients, the ORR was 94%, which included a 56% > or = VGPR rate (24% sCR/CR). The median CD34-positive stem cell collection was 10.67 x 10(6)/kg. The ORR after ASCT in 34 patients who were evaluable for response was 100%, including a 76% > or = VGPR rate (53% sCR/CR). Among all 44 patients, the median progression-free survival (PFS) was 27.4 months. The median overall survival (OS) was not reached after a median follow-up of 25 months, and the 2-year OS rate was 82%. There were no significant differences in PFS (27.4 months vs 23.5 months) or in 2-year survival (80% vs 90%) between patients who did and did not undergo ASCT, respectively. Twenty patients (45%) developed neuropathy, including 4 (9%) with grade 3 neuropathy episodes, and 1 patient developed deep vein thrombosis.

CONCLUSIONS

BTD was highly effective and well tolerated as induction for MM patients who were eligible for ASCT. Long-term outcomes appeared to be similar with or without ASCT consolidation.

Authors+Show Affiliations

Winship Cancer Institute, Emory University, Atlanta, Georgia 30322, USA. jlkaufm@emory.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

20564642

Citation

Kaufman, Jonathan L., et al. "Bortezomib, Thalidomide, and Dexamethasone as Induction Therapy for Patients With Symptomatic Multiple Myeloma: a Retrospective Study." Cancer, vol. 116, no. 13, 2010, pp. 3143-51.
Kaufman JL, Nooka A, Vrana M, et al. Bortezomib, thalidomide, and dexamethasone as induction therapy for patients with symptomatic multiple myeloma: a retrospective study. Cancer. 2010;116(13):3143-51.
Kaufman, J. L., Nooka, A., Vrana, M., Gleason, C., Heffner, L. T., & Lonial, S. (2010). Bortezomib, thalidomide, and dexamethasone as induction therapy for patients with symptomatic multiple myeloma: a retrospective study. Cancer, 116(13), 3143-51. https://doi.org/10.1002/cncr.25143
Kaufman JL, et al. Bortezomib, Thalidomide, and Dexamethasone as Induction Therapy for Patients With Symptomatic Multiple Myeloma: a Retrospective Study. Cancer. 2010 Jul 1;116(13):3143-51. PubMed PMID: 20564642.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Bortezomib, thalidomide, and dexamethasone as induction therapy for patients with symptomatic multiple myeloma: a retrospective study. AU - Kaufman,Jonathan L, AU - Nooka,Ajay, AU - Vrana,Mark, AU - Gleason,Charise, AU - Heffner,L Thompson, AU - Lonial,Sagar, PY - 2010/6/22/entrez PY - 2010/6/22/pubmed PY - 2010/7/16/medline SP - 3143 EP - 51 JF - Cancer JO - Cancer VL - 116 IS - 13 N2 - BACKGROUND: This single-center retrospective study determined the efficacy of bortezomib, thalidomide, and dexamethasone (BTD) as induction for patients with multiple myeloma (MM) who were eligible for autologous stem cell transplantation (ASCT). METHODS: Patients with symptomatic MM who had received BTD induction before stem cell collection at Winship Cancer Institute were included. BTD induction comprised up to 8 3-week cycles of bortezomib 1.3 mg/m(2) on Days 1, 4, 8, and 11; thalidomide 100 mg daily; and dexamethasone 40 mg on Days 1 through 4 and Days 9 through 12. Stem cell mobilization involved granulocyte-colony-stimulating factor and/or cyclophosphamide. Response was assessed according to European Group for Blood and Marrow Transplantation criteria. RESULTS: Review of medical records identified 44 eligible patients (34 patients who were treated in the front-line setting and 10 patients who were treated for recurrent disease) who received a median of 4 BTD cycles. The overall response rate (ORR) was 91%, which included a greater than or equal to very good partial response (> or = VGPR) rate of 57% (including 20% stringent complete responses/complete response [sCR/CR] rate). In front-line patients, the ORR was 94%, which included a 56% > or = VGPR rate (24% sCR/CR). The median CD34-positive stem cell collection was 10.67 x 10(6)/kg. The ORR after ASCT in 34 patients who were evaluable for response was 100%, including a 76% > or = VGPR rate (53% sCR/CR). Among all 44 patients, the median progression-free survival (PFS) was 27.4 months. The median overall survival (OS) was not reached after a median follow-up of 25 months, and the 2-year OS rate was 82%. There were no significant differences in PFS (27.4 months vs 23.5 months) or in 2-year survival (80% vs 90%) between patients who did and did not undergo ASCT, respectively. Twenty patients (45%) developed neuropathy, including 4 (9%) with grade 3 neuropathy episodes, and 1 patient developed deep vein thrombosis. CONCLUSIONS: BTD was highly effective and well tolerated as induction for MM patients who were eligible for ASCT. Long-term outcomes appeared to be similar with or without ASCT consolidation. SN - 0008-543X UR - https://www.unboundmedicine.com/medline/citation/20564642/Bortezomib_thalidomide_and_dexamethasone_as_induction_therapy_for_patients_with_symptomatic_multiple_myeloma:_a_retrospective_study_ L2 - https://doi.org/10.1002/cncr.25143 DB - PRIME DP - Unbound Medicine ER -