Bortezomib administered pre-auto-SCT and as maintenance therapy post transplant for multiple myeloma: a single institution phase II study.
The appropriate induction therapy before and the role of maintenance therapy after auto-SCT for patients with multiple myeloma remain areas of active investigation. We conducted a study in 40 patients with bortezomib given sequentially pre-auto-SCT and as maintenance therapy post auto-SCT. Pre-transplant bortezomib was administered for two cycles followed by high-dose melphalan 200 mg/m(2) with auto-SCT of G-CSF-mobilized PBMCs. Post transplant bortezomib was administered weekly for 5 out of 6 weeks for six cycles. No adverse effects were observed on stem cell mobilization or engraftment. An overall response rate of 83% with a CR+very good partial remission (VGPR) of 50% was observed with this approach. Three-year Kaplan-Meier estimates of disease-free survival and overall survival (OS) were 38.2 and 63.1%, respectively. Bortezomib reduced CD8(+) cytotoxic T cell and CD56(+) natural killer cell PBL subsets and was clinically associated with high rates of viral reactivation to varicella zoster.
Uy
G L
GL
Division of Oncology, Section of Bone Marrow Transplantation and Leukemia, Washington University School of Medicine, St Louis, MO 63110, USA. guy@im.wustl.edu
Goyal
S D
SD
Fisher
N M
NM
Oza
A Y
AY
Tomasson
M H
MH
Stockerl-Goldstein
K
K
DiPersio
J F
JF
Vij
R
R
D000328:Adult; D000368:Aged; D001897:Boronic Acids / Q000008:administration & dosage* / Q000009:adverse effects; D000069286:Bortezomib; D005260:Female; D016179:Granulocyte Colony-Stimulating Factor / Q000008:administration & dosage; D019650:Hematopoietic Stem Cell Mobilization; D014645:Herpesvirus 3, Human / Q000187:drug effects; D006801:Humans; D007694:Killer Cells, Natural / Q000187:drug effects; D016131:Lymphocyte Subsets; D008297:Male; D008558:Melphalan / Q000008:administration & dosage; D008875:Middle Aged; D009101:Multiple Myeloma / Q000188:drug therapy / Q000628:therapy*; D036102:Peripheral Blood Stem Cell Transplantation / Q000379:methods*; D011719:Pyrazines / Q000008:administration & dosage* / Q000009:adverse effects; D012074:Remission Induction; D016019:Survival Analysis; D013602:T-Lymphocytes, Cytotoxic / Q000187:drug effects; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D014775:Virus Activation / Q000187:drug effects
D001897:Boronic Acids; D011719:Pyrazines; D016179:Granulocyte Colony-Stimulating Factor; D000069286:Bortezomib; D008558:Melphalan