title: Bortezomib, Thalidomide and Lenalidomide: Have They Really Changed the Outcome of Multiple Myeloma?
abstract: Treatment of multiple myeloma (MM) has significantly improved, although the disease remains incurable. Prospective clinical trials evaluating the impact on outcome of new drugs such as proteasome inhibitors or immunomodulating agents are limited since they are not able to reflect the clinical routine and available retrospective data are not detailed enough to directly evaluate the value of new drugs. To address these information gaps, we performed a retrospective real-life analysis. We retrospectively assessed 949 patients treated for multiple myeloma or plasma cell leukemia at three Italian cancer centers in the years 1979-2014. Clinical features at the time of diagnosis were consistent with what was observed in clinical routine. A total of 39% of patients underwent high-dose chemotherapy followed by autologous stem cell transplantation (ASCT). The median overall survival (OS) of the whole group was 5.4 years and ranged from 3.4 years for patients who did not receive at least one of the new drugs compared to 5.9 years in the other patients (p<0.001). The improvement in OS due to administration of new drugs was also observed among different prognostic sub-groups such as age, Durie and Salmon stage, international staging system and renal impairment. Availability of new drugs significantly improved survival of patients who underwent ASCT and also those who did not. In conclusion, we provided evidence that the advent of the new drugs drastically improved the outcome of patients with MM, also in cases with poor risk at the time of diagnosis. ASCT is still of major importance in the treatment of this disease. Nevertheless, MM remains incurable and new therapeutic approaches are warranted.
authors.affiliation: Department of Hematology & Center of Bone Marrow Transplantation, Ospedale di Bolzano, Bolzano, Italy Department of Internal Medicine V (Haematology and Oncology), Medical University of Innsbruck, Innsbruck, Austria m.mian@med-sci.eu.
authors.forename: Michael
authors.initials: M
authors.lastname: Mian
authors.affiliation: Department of Medicine, Section of Hematology, University Hospital of Verona, Verona, Italy.
authors.forename: Martina
authors.initials: M
authors.lastname: Tinelli
authors.affiliation: Department of Medicine, Hematology and Clinical Immunology, Padua University School of Medicine, Padua, Italy.
authors.forename: Elena
authors.initials: E
authors.lastname: DE March
authors.affiliation: Department of Medicine, Hematology and Clinical Immunology, Padua University School of Medicine, Padua, Italy.
authors.forename: Gloria
authors.initials: G
authors.lastname: Turri
authors.affiliation: Department of Medicine, Section of Hematology, University Hospital of Verona, Verona, Italy.
authors.forename: Vittorio
authors.initials: V
authors.lastname: Meneghini
authors.affiliation: Department of Hematology & Center of Bone Marrow Transplantation, Ospedale di Bolzano, Bolzano, Italy.
authors.forename: Norbert
authors.initials: N
authors.lastname: Pescosta
authors.affiliation: Department of Medicine, Hematology and Clinical Immunology, Padua University School of Medicine, Padua, Italy.
authors.forename: Tamara
authors.initials: T
authors.lastname: Berno
authors.affiliation: Department of Hematology & Center of Bone Marrow Transplantation, Ospedale di Bolzano, Bolzano, Italy.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Marabese
authors.affiliation: Department of Human Pathology, University of Messina, Messina, Italy.
authors.forename: Patrizia
authors.initials: P
authors.lastname: Mondello
authors.affiliation: Department of Hematology, University of Udine, Udine, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Patriarca
authors.affiliation: Department of Medicine, Section of Hematology, University Hospital of Verona, Verona, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Pizzolo
authors.affiliation: Department of Medicine, Hematology and Clinical Immunology, Padua University School of Medicine, Padua, Italy.
authors.forename: Gianpietro
authors.initials: G
authors.lastname: Semenzato
authors.affiliation: Unit of Medical Oncology and Hematology, Clinical Institute Humanitas-Gavazzeni, Bergamo, Italy.
authors.forename: Sergio
authors.initials: S
authors.lastname: Cortelazzo
authors.affiliation: Department of Medicine, Hematology and Clinical Immunology, Padua University School of Medicine, Padua, Italy.
authors.forename: Renato
authors.initials: R
authors.lastname: Zambello
mesh_terms: D000069286:Bortezomib / Q000008:administration & dosage* / Q000627:therapeutic use; D006801:Humans; D000077269:Lenalidomide; D007952:Leukemia, Plasma Cell / Q000188:drug therapy* / Q000601:surgery; D009101:Multiple Myeloma / Q000188:drug therapy* / Q000601:surgery; D011379:Prognosis; D012189:Retrospective Studies; D033581:Stem Cell Transplantation; D016019:Survival Analysis; D013792:Thalidomide / Q000008:administration & dosage* / Q000031:analogs & derivatives* / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D013792:Thalidomide; D000069286:Bortezomib; D000077269:Lenalidomide
keywords: Multiple myeloma; bortezomib; lenalidomide; thalidomide