Posted: Thursday, January 12, 2023
The addition of bortezomib and lenalidomide to the autologous stem cell transplantation (ASCT) protocol may improve the overall survival of patients with multiple myeloma, according to a multi-institutional report from the Canadian Myeloma Research Group, presented at the 2022 American Society of Hematology (ASH) Annual Meeting and Exposition (Abstract 117). However, additional information regarding treatment details and patient characteristics are needed to determine the full extent of this protocol modification’s efficacy, explained Julie Cote, MD, of Hôpital de l’Enfant-Jésus, Quebec, and colleagues.
From 2007 to 2021, a total of 3,821 patients with multiple myeloma who had received ASCT as front-line therapy were recruited for the study. Of them, 82% received bortezomib-based induction therapy. A total of 376 patients demonstrated a suboptimal response or disease progression upon initial induction therapy and subsequently received a second induction therapy. Lenalidomide was used in 70.5% of these patients. Additionally, 314 patients received tandem ASCT as compared with single ASCT.
After completion of ASCT, 205 patients received combination consolidation therapy with a proteasome inhibitor plus lenalidomide. A total of 2,060 patients received post-ASCT maintenance therapy with lenalidomide (63.1%), bortezomib (2.1%), combined lenalidomide plus bortezomib (1.7%), proteasome inhibitors (1.6%), combined lenalidomide plus a proteasome inhibitor (5.7%), or thalidomide (8.5%) plus or minus combined steroid therapy.
The study findings revealed a median overall survival of 125 months and a median progression-free survival of 35.4 months after the first ASCT. For patients who received additional induction therapy, a decrease in median overall survival (118 months) and median progression-free survival rates (27.9 months) was observed. However, patients who received secondary induction therapy with associated maintenance therapy did not have any significant differences in outcomes. Moreover, patients treated with consolidation therapy demonstrated increased median progression-free survival (55.3 months vs. 34.4 months) but no differences in median overall survival. The median overall survival (159 months vs. 105 months) and median progression-free survival (48.8 months vs. 24.5 months) were improved for patients who received maintenance therapy compared with those who did not.
Disclosure: For full disclosures of the study authors, visit ash.confex.com.
2022 ASH Annual Meeting and Exposition