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, 8 (12), 125

Overall Survival of Transplant Eligible Patients With Newly Diagnosed Multiple Myeloma: Comparative Effectiveness Analysis of Modern Induction Regimens on Outcome

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Overall Survival of Transplant Eligible Patients With Newly Diagnosed Multiple Myeloma: Comparative Effectiveness Analysis of Modern Induction Regimens on Outcome

Ashley R Paquin et al. Blood Cancer J.

Abstract

Overall survival (OS) of multiple myeloma has improved remarkably over time, with the recent Intergroupe Francophone du Myelome (IFM) 2009 randomized trial reporting a 4-year OS rate of approximately 82% in patients receiving modern therapy. However, survival estimates from clinical trials may overestimate outcomes seen in clinical practice even with the adjustment for age and other key characteristics. The purpose of this study was to determine the OS of myeloma patients seen in routine clinical practice who resembled the cohort studied in the IFM 2009 trial. A second goal was to conduct a brief comparative effectiveness analysis of bortezomib, lenalidomide, dexamethasone, and other major induction regimens used during the study period. We studied all patients with myeloma 65 years of age and younger, seen at the Mayo Clinic between January 1, 2010 and August 31, 2015, who had a stem cell harvest performed within 12 months of initial diagnosis. Patients with baseline serum creatinine >2 mg/dL were excluded. Five hundred and eighteen patients were studied. The 4-year OS rate was 82.3%, comparable to results achieved in the contemporaneous IFM randomized trial. The 4-year OS rates for standard and high-risk myeloma were 86.3% and 68.2%, respectively.

Conflict of interest statement

A.D.—Celgene, Takeda, Pfizer, Prothena, and Alnylam (research funding). M.A.G.—Johnson and Johnson (honoraria). P.K.—Takeda, Amgen, and Sanofi (research funding), and Celgene and Sanofi (consulting fees). Y.L.—Janssen (research funding). S.K.K.—Abbvie, Celgene, Janssen, Merck, Novartis, Roche, Sanofi, and Takeda (research funding), and Skyline Diagnostics (honoraria). The remaining authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1. Overall survival.
The 4-year overall survival rate of the whole cohort was 82%; 5-year overall survival rate was 76.1%
Fig. 2
Fig. 2. Overall survival by cytogenetic risk stratification.
Median overall survival not reached (standard-risk myeloma; blue curve) versus 67.4 months (high-risk myeloma; red curve), P < 0.001; corresponding 4-year overall survival rates were 86.3% and 68.2%, respectively
Fig. 3
Fig. 3. Overall survival by induction treatment regimen.
4-year overall survival rates with immunomodulatory drug–proteasome inhibitor combination (n = 145; blue curve), proteasome inhibitor–alkylator combination (n = 160; green curve), and a doublet regimen (n = 192; red curve) were similar, 80.6%, 79.9%, and 83.6%, respectively, P = 0.67
Fig. 4
Fig. 4. Progression-free survival by induction treatment regimen.
Progression-free survival with immunomodulatory drug–proteasome inhibitor combination (n = 145), proteasome inhibitor–alkylator combination (n = 160), and a doublet regimen (n = 192) were similar. Median progression-free survival was 35.4 months (immunomodulatory drug–proteasome inhibitor combination; blue curve), 31.2 months (proteasome inhibitor–alkylator combination; green curve), and 30.1 months (doublet regimen; red curve), P = 0.5

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