Impact of novel agents followed by autologous hematopoietic stem cell transplantation for multiple myeloma patients aged 65 years or older: a retrospective single Institutional analysis

Minoia, Carla; Pisapia, Giovanni; Palazzo, Giulia; Ingrosso, Claudia; Buonanno, M.; Spinosa, Caterina; Prudenzano, A; Pricolo, Giancarla; Mazza, Patrizio

doi:10.1038/bmt.2015.185

Cited by 2 publications

(2 citation statements)

References 7 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Evidence suggests that fit patients aged >65 years can benefit from ASCT, especially when combined with regimens containing novel agents. 3 , 39 , 40 Our approach may also explain the relatively lower proportion of patients proceeding to ASCT in this study than in other studies of induction therapy which are usually limited only to patients under the age of 65. The most common reason for patients not proceeding to stem-cell transplant was given as “patient not fit/clinician’s decision” suggesting that clinicians may have initially entered patients in the transplant-eligible pathway of the study as a ‘trial of fitness’ so as not to limit their options prior to withdrawing the patient nearer the time of transplantation.…”

Section: Discussionmentioning

confidence: 81%

Lenalidomide before and after autologous stem cell transplantation for transplant-eligible patients of all ages in the randomized, phase III, Myeloma XI trial

et al. 2020

View full text Add to dashboard Cite

Publisher's Disclaimer. E-publishing ahead of print is increasingly important for the rapid dissemination of science.Haematologica is, therefore, E-publishing PDF files of an early version of manuscripts thathave completed a regular peer review and have been accepted for publication. E-publishingof this PDF file has been approved by the authors. After having E-published Ahead ofPrint, manuscripts will then undergo technical and English editing, typesetting, proof correction and be presented for the authors' final approval; the final version of the manuscriptwill then appear in print on a regular issue of the journal. All legal disclaimers thatapply to the journal also pertain to this production process.

show abstract

Section: Discussionmentioning

confidence: 81%

Lenalidomide before and after autologous stem cell transplantation for transplant-eligible patients of all ages in the randomized, phase III, Myeloma XI trial

et al. 2020

View full text Add to dashboard Cite

show abstract

“…PFS and OS are comparable with those reported in elderly patients who received novel agent-based combinations followed by autologous stem cell transplantation, but mainly in populations aged 65 to 70 years. 17 Randomized trials would be necessary to compare both approaches.…”

Section: Discussionmentioning

confidence: 99%

Sequential vs alternating administration of VMP and Rd in elderly patients with newly diagnosed MM

Mateos

Martínez‐López

Hernández

et al. 2016

Blood

View full text Add to dashboard Cite

Key Points• The sequential and alternating administration of VMP and Rd have equal efficacy and toxicity.• The greatest benefit of this total therapy approach was observed for patients aged 65 to 75 years.Bortezomib plus melphalan and prednisone (VMP) and lenalidomide plus low-dose dexamethasone (Rd) are 2 standards of care for elderly untreated multiple myeloma (MM) patients. We planned to use VMP and Rd for 18 cycles in a sequential or alternating scheme. Patients (233) with untreated MM, >65 years, were randomized to receive 9 cycles of VMP followed by 9 cycles of Rd (sequential scheme; n 5 118) vs 1 cycle of VMP followed by 1 cycle of Rd, and so on, up to 18 cycles (alternating scheme; n 5 115). VMP consisted of one 6-week cycle of bortezomib using a biweekly schedule, followed by eight 5-week cycles of once-weekly VMP. Rd included nine 4-week cycles of Rd. The primary end points were 18-month progression free survival (PFS) and safety profile of both schemes. The 18-month PFS was 74% and 80% in the sequential and alternating arms, respectively (P 5 .21). The sequential and alternating groups exhibited similar hematologic and nonhematologic toxicity. Both arms yielded similar complete response rate (42% and 40%), median PFS (32 months vs 34 months, P 5 .65), and 3-year overall survival (72% vs 74%, P 5 .63). The benefit of both schemes was remarkable in patients aged 65 to 75 years. In addition, achieving complete and immunophenotypic response was associated with better outcome. The present approach, based on VMP and Rd, is associated with high efficacy and acceptable toxicity profile with no differences between the sequential and alternating regimens. This trial was registered at www.clinicaltrials.gov as #NCT00443235. (Blood. 2016;127(4):420-425) IntroductionMultiple myeloma (MM) is the second most frequent hematologic disease. Two-thirds of newly diagnosed patients are older than 65 years. 1Treatment options for this patient population have previously been limited to alkylators, but new up-front combinations based on novel drugs, with or without alkylating agents, have significantly improved outcomes.2 Findings from 6 randomized trials showed that melphalan, prednisone, and thalidomide (MPT) was better than melphalan plus prednisone in terms of response rate and progression-free survival (PFS), with increased overall survival (OS) reported in 3 out of 5 trials. To date, MPT has been considered a standard of care.3 Bortezomib plus melphalan and prednisone (VMP) is another standard of care for elderly MM patients based on the VISTA (Velcade as Initial Standard Therapy in Multiple Myeloma) trial, in which VMP proved to be superior to melphalan and prednisone with an OS 4 benefit of 13 months. Moreover, bortezomib was subsequently optimized through weekly administration, which significantly improved tolerability but had no impact on the efficacy; this VMP "lite" is widely used in clinical practice.5 Concerning lenalidomide, the FIRST (Frontline Investigation of Lenalidomide plus dexamethasone vs Standard ...

show abstract

Impact of novel agents followed by autologous hematopoietic stem cell transplantation for multiple myeloma patients aged 65 years or older: a retrospective single Institutional analysis

Cited by 2 publications

References 7 publications

Lenalidomide before and after autologous stem cell transplantation for transplant-eligible patients of all ages in the randomized, phase III, Myeloma XI trial

Lenalidomide before and after autologous stem cell transplantation for transplant-eligible patients of all ages in the randomized, phase III, Myeloma XI trial

Sequential vs alternating administration of VMP and Rd in elderly patients with newly diagnosed MM

Contact Info

Product

Resources

About