Single agent dexamethasone for pre-stem cell transplant induction therapy for multiple myeloma

Abstract

Summary:Given the survival advantage, high-dose therapy (HDT) remains the standard of care for patients with multiple myeloma eligible for the procedure. For those undergoing HDT, initial therapy aimed at reducing tumor burden is given prior to stem cell harvest. Various regimens, mostly variations of VAD (vincristine, doxorubicin, dexamethasone), are used for induction therapy. We retrospectively evaluated if single agent dexamethasone would be an effective induction therapy, given that it is the most active drug in these combinations. A total of 35 patients who received induction therapy with dexamethasone alone were compared to a similar group of 72 patients who received VAD as the initial therapy. We found a 63% response rate with dexamethasone compared to 74% with VAD (P ¼ 0.25). Including minimal responses, the overall response rate for Dex and VAD was 74 and 86%, respectively (P ¼ 0.13). The overall and complete response rates to transplant, respectively, were 97 and 26% for the dexamethasone group and 100 and 39% for the VAD group; P ¼ 0.33 and 0.18. No significant differences were observed in the progression-free and overall survival at 1 year post transplant. Single agent dexamethasone appears to be an effective alternative to VAD for induction therapy prior to HDT in myeloma.

Clinical Impact of Bortezomib in Frontline Regimens for Patients with Multiple Myeloma

“…Just 6% of patients showed disease progression. The CR rate compares favorably with the 0% CR/nCR rate reported with other single agents, including dexamethasone [63,64] and thalidomide [65], used to treat frontline myeloma. A preliminary timeto-event analysis has been completed for 34 of these 66 patients; the median duration of best response was 8.5 months, while the median TTP was 6 months.…”

Management of Newly Diagnosed Symptomatic Multiple Myeloma: Updated Mayo Stratification of Myeloma and Risk-Adapted Therapy (mSMART) Consensus Guidelines 2013

“…59 Before the advent of IMiDs and bortezomib, single-agent dexamethasone (dex) and VAD (vincristine, Adriamycin (doxorubicin), dex) were the most commonly used approaches. [60][61][62] Several clinical trials were conducted in the past decade, first comparing these newer drugs in combination with dex against single-agent dex or VAD (Table 3). More recent trials have compared combinations of IMiDs and bortezomib together vs using them individually.…”

Impact of pretransplant therapy in patients with newly diagnosed myeloma undergoing autologous SCT

“…24 Treatment of patients with these regimens for 4-6 cycles typically resulted in response rates of 50-60% with only a small proportion of patients achieving a complete response prior to ASCT. [25][26][27] Previous studies have not demonstrated any long-term impact of the initial therapy on ASCT outcome in terms of TTP or survival, but these studies did not use novel agents in the induction phase. [6][7][8][9] The response status before the transplant had minimal impact on the eventual outcome of ASCT, with patients refractory to initial therapy obtaining as much benefit from the procedure as those who were responding to the pretransplant therapy.…”