title: Sequential bortezomib, dexamethasone, and thalidomide maintenance therapy after single autologous peripheral stem cell transplantation in patients with multiple myeloma.
abstract: We report feasibility and response results of a phase II study investigating prolonged weekly bortezomib and dexamethasone followed by thalidomide and dexamethasone as maintenance therapy after single autologous stem cell transplantation (ASCT) in patients with multiple myeloma. Within 4 to 8 weeks of ASCT, patients received weekly bortezomib and dexamethasone for six cycles, followed by thalidomide and dexamethasone for six more cycles. Thalidomide alone was continued until disease progression. Forty-five patients underwent ASCT. Forty patients started maintenance therapy; of these, 36 patients received four cycles, and 32 completed six cycles of maintenance bortezomib. Of these 40 patients, nine (22%) were in complete response (CR) before ASCT, 13 (32%) achieved CR after ASCT but before bortezomib maintenance therapy, and 21 (53%) achieved CR after bortezomib maintenance therapy. Nine patients not previously in CR (33%) upgraded their response to CR with bortezomib maintenance. At 1 year post-ASCT, 20 patients achieved CR, and two achieved very good partial response. Twenty-seven patients experienced peripheral neuropathy during bortezomib therapy, all grade 1 or 2. Our findings indicate that prolonged sequential weekly bortezomib, dexamethasone, and thalidomide maintenance therapy after single ASCT is feasible and well tolerated. Bortezomib maintenance treatment upgraded post-ASCT CR responses with no severe grade 3/4 peripheral neuropathy.
authors.affiliation: Department of Hematology and HCT, City of Hope, Duarte, California 91010, USA. fsahebi@coh.org
authors.forename: Firoozeh
authors.initials: F
authors.lastname: Sahebi
authors.forename: Paul H
authors.initials: PH
authors.lastname: Frankel
authors.forename: Len
authors.initials: L
authors.lastname: Farol
authors.forename: Amrita Y
authors.initials: AY
authors.lastname: Krishnan
authors.forename: Ji-lian
authors.initials: JL
authors.lastname: Cai
authors.forename: George
authors.initials: G
authors.lastname: Somlo
authors.forename: Sandra H
authors.initials: SH
authors.lastname: Thomas
authors.forename: Eunicia
authors.initials: E
authors.lastname: Reburiano
authors.forename: Leslie L
authors.initials: LL
authors.lastname: Popplewell
authors.forename: Pablo M
authors.initials: PM
authors.lastname: Parker
authors.forename: Ricardo T
authors.initials: RT
authors.lastname: Spielberger
authors.forename: Neil M
authors.initials: NM
authors.lastname: Kogut
authors.forename: Chatchada
authors.initials: C
authors.lastname: Karanes
authors.forename: Myo
authors.initials: M
authors.lastname: Htut
authors.forename: Christopher
authors.initials: C
authors.lastname: Ruel
authors.forename: Lupe
authors.initials: L
authors.lastname: Duarte
authors.forename: Joyce L
authors.initials: JL
authors.lastname: Murata-Collins
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Forman
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage* / Q000009:adverse effects; D001897:Boronic Acids / Q000008:administration & dosage / Q000009:adverse effects; D000069286:Bortezomib; D003907:Dexamethasone / Q000008:administration & dosage / Q000009:adverse effects; D018450:Disease Progression; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D036102:Peripheral Blood Stem Cell Transplantation / Q000379:methods*; D011719:Pyrazines / Q000008:administration & dosage / Q000009:adverse effects; D016019:Survival Analysis; D013792:Thalidomide / Q000008:administration & dosage / Q000009:adverse effects; D016896:Treatment Outcome
chemical_list: D001897:Boronic Acids; D011719:Pyrazines; D013792:Thalidomide; D000069286:Bortezomib; D003907:Dexamethasone