title: Bortezomib induction, reduced-intensity transplantation, and lenalidomide consolidation-maintenance for myeloma: updated results.
abstract: A sequential approach including bortezomib induction, intermediate-dose melphalan, and autologous stem cell transplantation (ASCT), followed by lenalidomide consolidation-maintenance, has been evaluated. Efficacy and safety data have been analyzed on intention-to-treat and results updated. Newly diagnosed myeloma patients 65 to 75 years of age (n = 102) received 4 cycles of bortezomib-pegylated liposomal doxorubicin-dexamethasone, tandem melphalan (100 mg/m(2)) followed by ASCT (MEL100-ASCT), 4 cycles of lenalidomide-prednisone consolidation (LP), and lenalidomide maintenance (L) until disease progression. The complete response (CR) rate was 33% after MEL100-ASCT, 48% after LP and 53% after L maintenance. After a median follow-up of 66 months, median time-to-progression (TTP) was 55 months and median progression-free survival 48 months. Median overall survival (OS) was not reached, 5-year OS was 63%. In CR patients, median TTP was 70 months and 5-year OS was 83%. Median survival from relapse was 28 months. Death related to adverse events (AEs) occurred in 8/102 patients during induction or transplantation. Rate of death related to AEs was higher in patients ≥70 years compared with younger (5/26 vs 3/76, P = .024). Bortezomib-induction followed by ASCT and lenalidomide consolidation-maintenance is a valuable option for elderly myeloma patients, with the greatest benefit in those younger than 70 years of age.
authors.affiliation: Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospedaliera Città della Salute e della Scienza di Torino, Turin, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Gay
authors.forename: Valeria
authors.initials: V
authors.lastname: Magarotto
authors.forename: Claudia
authors.initials: C
authors.lastname: Crippa
authors.forename: Norbert
authors.initials: N
authors.lastname: Pescosta
authors.forename: Tommasina
authors.initials: T
authors.lastname: Guglielmelli
authors.forename: Federica
authors.initials: F
authors.lastname: Cavallo
authors.forename: Sara
authors.initials: S
authors.lastname: Pezzatti
authors.forename: Samantha
authors.initials: S
authors.lastname: Ferrari
authors.forename: Anna Marina
authors.initials: AM
authors.lastname: Liberati
authors.forename: Stefania
authors.initials: S
authors.lastname: Oliva
authors.forename: Francesca
authors.initials: F
authors.lastname: Patriarca
authors.forename: Massimo
authors.initials: M
authors.lastname: Offidani
authors.forename: Paola
authors.initials: P
authors.lastname: Omedé
authors.forename: Vittorio
authors.initials: V
authors.lastname: Montefusco
authors.forename: Maria Teresa
authors.initials: MT
authors.lastname: Petrucci
authors.forename: Nicola
authors.initials: N
authors.lastname: Giuliani
authors.forename: Roberto
authors.initials: R
authors.lastname: Passera
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Pietrantuono
authors.forename: Mario
authors.initials: M
authors.lastname: Boccadoro
authors.forename: Paolo
authors.initials: P
authors.lastname: Corradini
authors.forename: Antonio
authors.initials: A
authors.lastname: Palumbo
mesh_terms: D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001897:Boronic Acids / Q000008:administration & dosage*; D000069286:Bortezomib; D003907:Dexamethasone / Q000008:administration & dosage; D018450:Disease Progression; D018572:Disease-Free Survival; D004317:Doxorubicin / Q000008:administration & dosage / Q000031:analogs & derivatives; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D000077269:Lenalidomide; D008297:Male; D008558:Melphalan / Q000008:administration & dosage*; D008875:Middle Aged; D009101:Multiple Myeloma / Q000401:mortality / Q000628:therapy*; D011092:Polyethylene Glycols / Q000008:administration & dosage; D011719:Pyrazines / Q000008:administration & dosage*; D012008:Recurrence; D033581:Stem Cell Transplantation / Q000379:methods*; D013792:Thalidomide / Q000008:administration & dosage / Q000031:analogs & derivatives*; D014182:Transplantation, Autologous / Q000379:methods; D016896:Treatment Outcome
chemical_list: D001897:Boronic Acids; D011719:Pyrazines; C506643:liposomal doxorubicin; D011092:Polyethylene Glycols; D013792:Thalidomide; D000069286:Bortezomib; D003907:Dexamethasone; D004317:Doxorubicin; D000077269:Lenalidomide; D008558:Melphalan