Consolidation and maintenance therapy with lenalidomide, bortezomib and dexamethasone (RVD) in high-risk myeloma patients.
Prior studies have shown that myeloma patients exhibiting either genetically defined high-risk disease or plasma cell leukemia have a poor outcome with a median overall survival (OS) of ≤3 years. Results of IFM 2005-01 and 02 suggest that relatively limited bortezomib-containing induction regimens did not produce a major survival benefit among these patients. However, results of recent studies suggest that combination therapy may benefit these patients when given early and again later in the treatment. We evaluated a combination maintenance/consolidation regimen (RVD) following autologous stem cell transplant (ASCT) for high-risk patients to evaluate the impact of this approach on outcome. Following initiation of RVD maintenance, 51% of patients achieved stringent complete response (sCR), with 96% achieving at least VGPR as best response. Median progression free survival (PFS) for all patients is 32 months with a 3-year OS of 93%. The regimen was well tolerated with no grade 3/4 neuropathy. Early ASCT followed by RVD maintenance is a promising strategy for high-risk myeloma patients and delivered excellent response rates, and promising PFS and OS.
Department of Hematology and Medical Oncology Winship Cancer Center, Emory University, Atlanta, GA, USA.
A K
AK
Nooka
Department of Hematology and Medical Oncology Winship Cancer Center, Emory University, Atlanta, GA, USA.
J L
JL
Kaufman
Department of Hematology and Medical Oncology Winship Cancer Center, Emory University, Atlanta, GA, USA.
S
S
Muppidi
Department of Hematology and Medical Oncology Winship Cancer Center, Emory University, Atlanta, GA, USA.
A
A
Langston
Department of Hematology and Medical Oncology Winship Cancer Center, Emory University, Atlanta, GA, USA.
L T
LT
Heffner
Department of Hematology and Medical Oncology Winship Cancer Center, Emory University, Atlanta, GA, USA.
C
C
Gleason
Department of Hematology and Medical Oncology Winship Cancer Center, Emory University, Atlanta, GA, USA.
D
D
Casbourne
Department of Pathology, Emory University School of Medicine, Atlanta, GA, USA.
D
D
Saxe
Department of Hematology and Medical Oncology Winship Cancer Center, Emory University, Atlanta, GA, USA.
L H
LH
Boise
Department of Hematology and Medical Oncology Winship Cancer Center, Emory University, Atlanta, GA, USA.
S
S
Lonial
D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001897:Boronic Acids / Q000008:administration & dosage; D000069286:Bortezomib; D003907:Dexamethasone / Q000008:administration & dosage; D005260:Female; D006801:Humans; D000077269:Lenalidomide; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000188:drug therapy*; D011719:Pyrazines / Q000008:administration & dosage; D013792:Thalidomide / Q000008:administration & dosage / Q000031:analogs & derivatives
D001897:Boronic Acids; D011719:Pyrazines; D013792:Thalidomide; D000069286:Bortezomib; D003907:Dexamethasone; D000077269:Lenalidomide