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Bortezomib, Lenalidomide, and Dexamethasone (VRd) Followed by Autologous Stem Cell Transplant for Multiple Myeloma

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Bortezomib, Lenalidomide, and Dexamethasone (VRd) Followed by Autologous Stem Cell Transplant for Multiple Myeloma

M Hasib Sidiqi et al. Blood Cancer J.

Abstract

We retrospectively reviewed all patients (n = 243) receiving bortezomib, lenalidomide, and dexamethasone (VRd) induction followed by autologous stem cell transplantation (ASCT) for multiple myeloma at the Mayo Clinic between January 2010 and April of 2017. Median age was 61 (interquartile range, 55-67) with 62% of patients being male. High-risk cytogenetic abnormalities (HRA) were present in 34% of patients. A total of 166 (68%) patients received some form of maintenance/other therapy post transplant (no maintenance (NM, n = 77), lenalidomide maintenance (LM, n = 108), bortezomib maintenance (BM, n = 39), and other therapy (OT, n = 19)). Overall response rate at day 100 post ASCT was 99% (CR 42%) with CR rate increasing to 62% at time of best response post transplant. Two year and 5 year overall survival rates were 90% and 67%, respectively, with an estimated median overall survival (OS) and progression-free survival (PFS) of 96 and 28 months, respectively. HRA was associated with a worse OS but not PFS (median OS: not reached for standard risk vs 60 months for HRA, P = 0.0006; median PFS: 27 months for standard risk vs 22 months for HRA, P = 0.70). The combination of VRd followed by ASCT is a highly effective regimen producing deep and durable responses in many patients.

Conflict of interest statement

Conflict of interest

M.A.G. received consultancy fromMillenium and honoraria from Celgene, Millenium, Onyx, Novartis, SmithKline, Prothena, Ionis, and Amgen. S.K.K. received consultancy from Celgene, Millennium, Onyx, Janssen, and BMS and research funding from Celgene, Millennium, Novartis, Onyx AbbVie, Janssen, and BMS. M.Q.L. received research funding from Celgene. D.D. received research funding from Karyopharm Therapeutics, Amgen, and Millenium Pharmaceuticals. P.K. received research funding from Takeda, Celgene, and Amgen. A.D. received research funding from Celgene, Millennium, Pfizer, and Janssen and travel grant from Pfizer. The remaining authors declare that they have no conflict of interest..

Institutional review board

The study was approved by the Mayo Clinic institutional review board.

Figures

Fig. 1
Fig. 1. Response to therapy.
Hematologic response at day 100 (a) and best response post transplant (b). sCR stringent complete response, CR complete response, VGPR very good partial response, PR partial response, NR no response
Fig. 2
Fig. 2. Overall and progression-free survival by post-transplant therapy.
a Overall survival. b Progression-free survival. NM no maintenance, LM lenalidomide maintenance, BM bortezomib maintenance, OT other therapy, NR not reached
Fig. 3
Fig. 3. Survival by cytogenetics.
a Overall survival. b Progression-free survival
Fig. 4
Fig. 4. Survival by cytogenetics and post-transplant therapy.
a, b Overall and progression-free survival by cytogenetic risk in patients receiving no maintenance. c, d Overall and progression-free survival by cytogenetic risk in patients receiving maintenance/other therapy

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