title: Early versus delayed autologous stem cell transplant in patients receiving novel therapies for multiple myeloma.
abstract: Autologous stem cell transplant (ASCT) is an effective treatment for multiple myeloma (MM). However, the timing of ASCT in the era of novel agents (lenalidomide, thalidomide, bortezomib) is unknown. We retrospectively reviewed the outcome of patients with MM who received novel agent-based induction treatment and received first ASCT within 12 months of diagnosis (early ASCT, n = 102) or at a later date (late ASCT, n = 65). Median time to ASCT was 7.9 months vs. 17.7 months in early vs. late ASCT. The 3- and 5-year overall survival (OS) from diagnosis was 90 and 63% vs. 82 and 63% in early and late ASCT, respectively (p = 0.45). Forty-one and 36 patients in the early and late ASCT groups have relapsed or progressed, with median time to relapse of 28 and 23 months (p = 0.055). On multivariable analysis, factors predictive of increased risk for progression were International Scoring System (ISS) stage III (p = 0.007), and less than a very good partial response (< VGPR) post-ASCT (p < 0.001). A factor predictive of worst outcome for OS was being on hemodialysis (p = 0.037). No superiority of one agent was seen. In summary, early or late ASCT is a viable option for patients with MM receiving induction treatment with novel targeted therapies.
authors.affiliation: Department of Internal Medicine, The Ohio State University Medical Center, Columbus, OH, USA.
authors.forename: Neil C
authors.initials: NC
authors.lastname: Dunavin
authors.forename: Lai
authors.initials: L
authors.lastname: Wei
authors.forename: Patrick
authors.initials: P
authors.lastname: Elder
authors.forename: Gary S
authors.initials: GS
authors.lastname: Phillips
authors.forename: Don M
authors.initials: DM
authors.lastname: Benson
authors.forename: Craig C
authors.initials: CC
authors.lastname: Hofmeister
authors.forename: Sam
authors.initials: S
authors.lastname: Penza
authors.forename: Carli
authors.initials: C
authors.lastname: Greenfield
authors.forename: Karen S
authors.initials: KS
authors.lastname: Rose
authors.forename: Gisele
authors.initials: G
authors.lastname: Rieser
authors.forename: Lisa
authors.initials: L
authors.lastname: Merritt
authors.forename: Jill
authors.initials: J
authors.lastname: Ketcham
authors.forename: Nyla
authors.initials: N
authors.lastname: Heerema
authors.forename: John C
authors.initials: JC
authors.lastname: Byrd
authors.forename: Steven M
authors.initials: SM
authors.lastname: Devine
authors.forename: Yvonne A
authors.initials: YA
authors.lastname: Efebera
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001897:Boronic Acids / Q000008:administration & dosage; D000069286:Bortezomib; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D060828:Induction Chemotherapy; D000077269:Lenalidomide; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000188:drug therapy / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D009367:Neoplasm Staging; D011379:Prognosis; D011719:Pyrazines / Q000008:administration & dosage; D012008:Recurrence; D012189:Retrospective Studies; D013792:Thalidomide / Q000008:administration & dosage / Q000031:analogs & derivatives; D014182:Transplantation, Autologous; D016896:Treatment Outcome
chemical_list: D001897:Boronic Acids; D011719:Pyrazines; D013792:Thalidomide; D000069286:Bortezomib; D000077269:Lenalidomide