Maintenance versus Induction Therapy Choice on Outcomes after Autologous Transplantation for Multiple Myeloma

摘要

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 prior to autologous hematopoietic cell transplantation (AHCT) for multiple myeloma (MM) in the US. 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 2008–2013. Analysis was limited to those receiving a single AHCT after one line of induction therapy within 12 months from treatment initiation for MM. In multivariate analysis, progression-free (PFS) and overall survival were similar irrespective of induction regimen. However high risk cytogenetics and non-receipt of post-transplant maintenance/consolidation therapy were associated with higher risk of relapse. Patients receiving post-transplant therapy had significantly improved 3-year PFS vs. no post-transplant therapy (55% vs. 39%, p=0.0001). This benefit was most evident in patients not achieving at least CR post-AHCT (p=0.005). 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.