title: Maintenance versus Induction Therapy Choice on Outcomes after Autologous Transplantation for Multiple Myeloma.
abstract: Bortezomib (V), lenalidomide (R), cyclophosphamide (C), and dexamethasone (D) are components of the most commonly used modern doublet (RD, VD) or triplet (VRD, CVD) initial induction regimens before autologous hematopoietic cell transplantation (AHCT) for multiple myeloma (MM) in the United States. In this study we evaluated 693 patients receiving "upfront" AHCT after initial induction therapy with modern doublet or triplet regimens using data reported to the Center for International Blood and Marrow Transplant Research from 2008 to 2013. Analysis was limited to those receiving a single AHCT after 1 line of induction therapy within 12 months from treatment initiation for MM. In multivariate analysis, progression-free survival (PFS) and overall survival were similar irrespective of induction regimen. However, high-risk cytogenetics and nonreceipt of post-transplant maintenance/consolidation therapy were associated with higher risk of relapse. Patients receiving post-transplant therapy had significantly improved 3-year PFS versus no post-transplant therapy (55% versus 39%, P = .0001). This benefit was most evident in patients not achieving at least a complete response post-AHCT (P = .005). In patients receiving upfront AHCT, the choice of induction regimen (doublet or triplet therapies) appears to be of lower impact than use of post-transplant therapy.
authors.affiliation: Division of Hematology/Oncology Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Robert F
authors.initials: RF
authors.lastname: Cornell
authors.affiliation: Center for International Blood and Marrow Transplant Research (CIBMTR), Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin. Electronic address: andsouza@mcw.edu.
authors.forename: Anita
authors.initials: A
authors.lastname: D'Souza
authors.affiliation: Division of Hematology/Oncology Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Adetola A
authors.initials: AA
authors.lastname: Kassim
authors.affiliation: Division of Hematology/Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: Luciano J
authors.initials: LJ
authors.lastname: Costa
authors.affiliation: Division of Hematology/Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: Racquel D
authors.initials: RD
authors.lastname: Innis-Shelton
authors.affiliation: Center for International Blood and Marrow Transplant Research (CIBMTR), Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin; Division of Biostatistics, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: Mei-Jie
authors.initials: MJ
authors.lastname: Zhang
authors.affiliation: Center for International Blood and Marrow Transplant Research (CIBMTR), Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: Jiaxing
authors.initials: J
authors.lastname: Huang
authors.affiliation: Division of BMT, Department of Oncology, Karmanos Cancer Institute, Wayne State University, Detroit, Michigan.
authors.forename: Muneer
authors.initials: M
authors.lastname: Abidi
authors.affiliation: Patient, San Jose, California.
authors.forename: Jack
authors.initials: J
authors.lastname: Aiello
authors.affiliation: Stem Cell Transplantation and Cell Therapy, Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois.
authors.forename: Gorgun
authors.initials: G
authors.lastname: Akpek
authors.affiliation: Blood and Marrow Transplant Program at Northside Hospital, Atlanta, Georgia.
authors.forename: Asad
authors.initials: A
authors.lastname: Bashey
authors.affiliation: Department of Stem Cell Transplantation, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Qaiser
authors.initials: Q
authors.lastname: Bashir
authors.affiliation: Division of Hematology and Oncology, Department of Medicine, UMass Memorial Medical Center, Worchester, Massachusetts.
authors.forename: Jan
authors.initials: J
authors.lastname: Cerny
authors.affiliation: Tufts Medical Center, Boston, Massachusetts.
authors.forename: Raymond
authors.initials: R
authors.lastname: Comenzo
authors.affiliation: Department of Hematology/Oncology, Hospital Infantil Universitario Nino Jesus, Madrid, Spain.
authors.forename: Miguel Angel
authors.initials: MA
authors.lastname: Diaz
authors.affiliation: South Texas Veterans Health Care System and University of Texas Health Science Center San Antonio, San Antonio, Texas.
authors.forename: César
authors.initials: C
authors.lastname: Freytes
authors.affiliation: Hematology Research Centre, Division of Experimental Medicine, Department of Medicine, Imperial College London, London, United Kingdom.
authors.forename: Robert Peter
authors.initials: RP
authors.lastname: Gale
authors.affiliation: Blood and Marrow Transplantation, Division of Hematology and Oncology, University of Kansas Medical Center, Kansas City, Kansas.
authors.forename: Siddhartha
authors.initials: S
authors.lastname: Ganguly
authors.affiliation: Center for International Blood and Marrow Transplant Research (CIBMTR), Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: Mehdi
authors.initials: M
authors.lastname: Hamadani
authors.affiliation: Mayo Clinic Rochester, Rochester, Minnesota.
authors.forename: Shahrukh
authors.initials: S
authors.lastname: Hashmi
authors.affiliation: Fred Hutchinson Cancer Research Center, Seattle, Washington.
authors.forename: Leona
authors.initials: L
authors.lastname: Holmberg
authors.affiliation: Fox Chase Cancer Center, Philadelphia, Pennsylvania.
authors.forename: Nasheed
authors.initials: N
authors.lastname: Hossain
authors.affiliation: Division of Hematology and Oncology, Center for Cell and Gene Therapy, Baylor College of Medicine, Houston, Texas.
authors.forename: Rammurti T
authors.initials: RT
authors.lastname: Kamble
authors.affiliation: Department of Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Kharfan-Dabaja
authors.affiliation: Division of Hematology/Oncology, University of Virginia Health System, Charlottesville, Virginia.
authors.forename: Tamila
authors.initials: T
authors.lastname: Kindwall-Keller
authors.affiliation: Mayo Clinic Rochester, Rochester, Minnesota.
authors.forename: Robert
authors.initials: R
authors.lastname: Kyle
authors.affiliation: Mayo Clinic Rochester, Rochester, Minnesota.
authors.forename: Shaji
authors.initials: S
authors.lastname: Kumar
authors.affiliation: Seidman Cancer Center, University Hospitals Case Medical Center, Cleveland, Ohio.
authors.forename: Hillard
authors.initials: H
authors.lastname: Lazarus
authors.affiliation: Royal Adelaide Hospital, Adelaide, South Australia, Australia.
authors.forename: Cindy
authors.initials: C
authors.lastname: Lee
authors.affiliation: Hospital Universitbrio Clementinio Fraga Filho, Universidade Federal do Rio de Janerio, Rio de Janerio, Brazil.
authors.forename: Angelo
authors.initials: A
authors.lastname: Maiolino
authors.affiliation: Adult Bone Marrow Transplant, University Hospitals Bristol NHS Trust, Bristol, United Kingdom.
authors.forename: David I
authors.initials: DI
authors.lastname: Marks
authors.affiliation: Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Meehan
authors.affiliation: Mayo Clinic Arizona and Phoenix Children's Hospital, Phoenix, Arizona.
authors.forename: Joe
authors.initials: J
authors.lastname: Mikhael
authors.affiliation: Division of Hematology and Oncology, Department of Medicine, UMass Memorial Medical Center, Worchester, Massachusetts.
authors.forename: Rajneesh
authors.initials: R
authors.lastname: Nath
authors.affiliation: Department of Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida.
authors.forename: Taiga
authors.initials: T
authors.lastname: Nishihori
authors.affiliation: Division of Therapeutic Immunology, Department of Laboratory Medicine, Karolinksa Institutet, Stockholm, Sweden; Centre for Clinical Research Sormland, Uppsala University, Uppsala, Sweden.
authors.forename: Richard F
authors.initials: RF
authors.lastname: Olsson
authors.affiliation: Division of Hematology and Oncology, Department of Medicine, UMass Memorial Medical Center, Worchester, Massachusetts.
authors.forename: Muthalagu
authors.initials: M
authors.lastname: Ramanathan
authors.affiliation: Division of Hematology/Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: Ayman
authors.initials: A
authors.lastname: Saad
authors.affiliation: National Cancer Research Center, East Hospital, Chiba, Japan.
authors.forename: Sachiko
authors.initials: S
authors.lastname: Seo
authors.affiliation: Department of Hematology v Medical Oncology, Levine Cancer Institute, Carolinas HealthCare System, Charlotte, North Carolina.
authors.forename: Saad
authors.initials: S
authors.lastname: Usmani
authors.affiliation: John Theurer Cancer Center at Hackensack UMC, Hackensack, New Jersey.
authors.forename: David
authors.initials: D
authors.lastname: Vesole
authors.affiliation: Divison of Hematology and Oncology, Washington University School of Medicine, St. Louis, Missouri.
authors.forename: Ravi
authors.initials: R
authors.lastname: Vij
authors.affiliation: Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Dan
authors.initials: D
authors.lastname: Vogl
authors.affiliation: Division of Bone Marrow Transplant, Seattle Cancer Care Alliance, Seattle, Washington.
authors.forename: Baldeep M
authors.initials: BM
authors.lastname: Wirk
authors.affiliation: Blood & Marrow Transplantation Program, Division of Hematology/Oncology, Department of Medicine, Greenebaum Cancer Center, University of Maryland, Baltimore, Maryland.
authors.forename: Jean
authors.initials: J
authors.lastname: Yared
authors.affiliation: City of Hope National Medical Center, Duarte, California.
authors.forename: Amrita
authors.initials: A
authors.lastname: Krishnan
authors.affiliation: Department of Medicine, Weill Cornell Medical College, New York, New York.
authors.forename: Tomer
authors.initials: T
authors.lastname: Mark
authors.affiliation: Department of Stem Cell Transplantation, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Yago
authors.initials: Y
authors.lastname: Nieto
authors.affiliation: Center for International Blood and Marrow Transplant Research (CIBMTR), Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: Parameswaran
authors.initials: P
authors.lastname: Hari
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D002423:Cause of Death; D003131:Combined Modality Therapy; D016208:Databases, Factual; D018572:Disease-Free Survival; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007155:Immunologic Factors / Q000008:administration & dosage; D017404:In Situ Hybridization, Fluorescence; D053208:Kaplan-Meier Estimate; D060046:Maintenance Chemotherapy; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000188:drug therapy* / Q000235:genetics / Q000628:therapy; D016609:Neoplasms, Second Primary / Q000401:mortality; D010523:Peripheral Nervous System Diseases / Q000139:chemically induced; D061988:Proteasome Inhibitors / Q000008:administration & dosage; D012074:Remission Induction; D012189:Retrospective Studies; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D007155:Immunologic Factors; D061988:Proteasome Inhibitors
keywords: Chemotherapy; Maintenance; Myeloma; Relapse; Survival; Transplantation