title: The response to second-line induction with bortezomib and dexamethasone is predictive of long-term outcomes prior to high-dose chemotherapy with autologous stem cell transplantation for multiple myeloma.
abstract: OBJECTIVE
  We retrospectively investigated the efficacy and predictive factors for the treatment outcomes of bortezomib plus dexamethasone (BD) as second-line induction therapy prior to high-dose chemotherapy supported by autologous stem cell transplantation (HDT/ASCT) in multiple myeloma (MM) patients.
  
  
  METHODS
  Sixty-six transplant eligible MM patients treated by the Kyoto Clinical Hematology Study Group between 2006 and 2011 were investigated. Conventional induction chemotherapy, including vincristine, doxorubicin and dexamethasone (VAD) and high-dose dexamethasone (HDD), was used as first-line induction therapy in all patients, seven (10.6%) of whom attained a very good partial response (VGPR). Of the 59 patients who did not attain VGPR with VAD or HDD, 33 were given BD as second-line induction therapy prior to HDT/ASCT.
  
  
  RESULTS
  Patients not treated with BD induction showed an overall response rate (ORR, i.e., better than partial response) of 85.3% after induction therapy, while the ORR of patients treated with BD induction improved from 42.4% after conventional induction therapy to 84.8% after BD. The overall survival (OS) and progression-free survival (PFS) of patients not treated with BD induction were not significantly influenced by the response to induction therapy. Among the patients treated with BD, failure in attaining VGPR prior to ASCT was associated with a significantly shorter PFS and it also tended to show a shorter OS, while the disease stage and achievement of a complete response after HDT/ASCT had no impact on OS or PFS.
  
  
  CONCLUSIONS
  The achievement of at least VGPR with second-line BD induction therapy is a prerequisite for attaining longer OS and PFS after HDT/ASCT.
authors: Division of Hematology and Oncology, Department of Medicine, Kyoto Prefectural University of Medicine, Japan. t-koba@koto.kpu-m.ac.jp
authors: Tsutomu
authors: T
authors: Kobayashi
authors: Junya
authors: J
authors: Kuroda
authors: Shin-ichi
authors: S
authors: Fuchida
authors: Satoshi
authors: S
authors: Murakami
authors: Mayumi
authors: M
authors: Hatsuse
authors: Akira
authors: A
authors: Okano
authors: Toshiki
authors: T
authors: Iwai
authors: Yasuhiko
authors: Y
authors: Tsutsumi
authors: Yuri
authors: Y
authors: Kamitsuji
authors: Teruaki
authors: T
authors: Akaogi
authors: Eri
authors: E
authors: Kawata-Iida
authors: Daisuke
authors: D
authors: Shimizu
authors: Hitoji
authors: H
authors: Uchiyama
authors: Yosuke
authors: Y
authors: Matsumoto
authors: Shigeo
authors: S
authors: Horiike
authors: Mitsushige
authors: M
authors: Nakao
authors: Ryoichi
authors: R
authors: Takahashi
authors: Hiroto
authors: H
authors: Kaneko
authors: Nobuhiko
authors: N
authors: Uoshima
authors: Yutaka
authors: Y
authors: Kobayashi
authors: Chihiro
authors: C
authors: Shimazaki
authors: Masafumi
authors: M
authors: Taniwaki
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D001897:Boronic Acids / Q000008:administration & dosage / Q000009:adverse effects; D000069286:Bortezomib; D002869:Chromosome Aberrations; D003131:Combined Modality Therapy; D003520:Cyclophosphamide / Q000008:administration & dosage; D003907:Dexamethasone / Q000008:administration & dosage / Q000009:adverse effects; D018572:Disease-Free Survival; D004317:Doxorubicin / Q000008:administration & dosage; D004334:Drug Administration Schedule; D005260:Female; D005544:Forecasting; D006402:Hematologic Diseases / Q000139:chemically induced; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008558:Melphalan / Q000008:administration & dosage; D008875:Middle Aged; D009101:Multiple Myeloma / Q000188:drug therapy* / Q000235:genetics / Q000601:surgery; D036102:Peripheral Blood Stem Cell Transplantation; D010523:Peripheral Nervous System Diseases / Q000139:chemically induced; D011241:Prednisone / Q000008:administration & dosage; D011719:Pyrazines / Q000008:administration & dosage / Q000009:adverse effects; D012074:Remission Induction; D012189:Retrospective Studies; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D014750:Vincristine / Q000008:administration & dosage
chemical_list: D001897:Boronic Acids; D011719:Pyrazines; D014750:Vincristine; D000069286:Bortezomib; D003907:Dexamethasone; D004317:Doxorubicin; D003520:Cyclophosphamide; D008558:Melphalan; D011241:Prednisone