title: Bortezomib administered pre-auto-SCT and as maintenance therapy post transplant for multiple myeloma: a single institution phase II study.
abstract: 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.
authors.affiliation: Division of Oncology, Section of Bone Marrow Transplantation and Leukemia, Washington University School of Medicine, St Louis, MO 63110, USA. guy@im.wustl.edu
authors.forename: G L
authors.initials: GL
authors.lastname: Uy
authors.forename: S D
authors.initials: SD
authors.lastname: Goyal
authors.forename: N M
authors.initials: NM
authors.lastname: Fisher
authors.forename: A Y
authors.initials: AY
authors.lastname: Oza
authors.forename: M H
authors.initials: MH
authors.lastname: Tomasson
authors.forename: K
authors.initials: K
authors.lastname: Stockerl-Goldstein
authors.forename: J F
authors.initials: JF
authors.lastname: DiPersio
authors.forename: R
authors.initials: R
authors.lastname: Vij
mesh_terms: 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
chemical_list: D001897:Boronic Acids; D011719:Pyrazines; D016179:Granulocyte Colony-Stimulating Factor; D000069286:Bortezomib; D008558:Melphalan