scholarly journals Consolidation and maintenance therapy for multiple myeloma after autologous transplantation: where do we stand?

2015 ◽  
Vol 50 (8) ◽  
pp. 1024-1029 ◽  
Author(s):  
M Mohty ◽  
P G Richardson ◽  
P L McCarthy ◽  
M Attal
Keyword(s):  
Multiple Myeloma ◽  
Maintenance Therapy ◽  
Autologous Transplantation

Single autologous stem-cell transplantation followed by maintenance therapy with thalidomide is superior to double autologous transplantation in multiple myeloma: results of a multicenter randomized clinical trial

Blood ◽  
2008 ◽  
Vol 111 (4) ◽  
pp. 1805-1810 ◽  
Author(s):  
Abderrahman Abdelkefi ◽  
Saloua Ladeb ◽  
Lamia Torjman ◽  
Tarek Ben Othman ◽  
Amel Lakhal ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Maintenance Therapy ◽  
Cell Transplantation ◽  
Autologous Stem Cell Transplantation ◽  
De Novo ◽  
Autologous Transplantation ◽  
High Dose ◽  
Peripheral Blood Stem Cells

From April 2003 to December 2006, 195 patients with de novo symptomatic myeloma and younger than 60 years of age were randomly assigned to receive either tandem transplantation up front (arm A, n = 97) or one autologous stem-cell transplantation followed by a maintenance therapy with thalidomide (day + 90, 100 mg per day during 6 months) (arm B, n = 98). Patients included in arm B received a second transplant at disease progression. In both arms, autologous stem-cell transplantation was preceded by first-line therapy with thalidomide-dexamethasone and subsequent collection of peripheral blood stem cells with high-dose cyclophosphamide (4 g/m2) and granulocyte colony stimulating factor. Data were analyzed on an intent-to-treat basis. With a median follow-up of 33 months (range, 6–46 months), the 3-year overall survival was 65% in arm A and 85% in arm B (P = .04). The 3-year progression-free survival was 57% in arm A and 85% in arm B (P = .02). Up-front single autologous transplantation followed by 6 months of maintenance therapy with thalidomide (with second transplant in reserve for relapse or progression) is an effective therapeutic strategy to treat multiple myeloma patients and appears superior to tandem transplant in this setting. This study was registered at www.ClinicalTrials.gov as (NCT 00207805).

scholarly journals Autologous Transplantation and Maintenance Therapy in Multiple Myeloma

2014 ◽  
Vol 371 (10) ◽  
pp. 895-905 ◽  
Author(s):  
Antonio Palumbo ◽  
Federica Cavallo ◽  
Francesca Gay ◽  
Francesco Di Raimondo ◽  
Dina Ben Yehuda ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Maintenance Therapy ◽  
Autologous Transplantation

scholarly journals Retrospective Analysis of 111 Cases of Multiple Myeloma Treated with Autologous Hematopoietic Stem Cell Transplantation

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 5833-5833
Author(s):  
Chengcheng Fu ◽  
Yun Xu ◽  
Juan Wang ◽  
Jin Zhou ◽  
Ling Ma ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Stem Cell ◽  
Hematopoietic Stem Cell Transplantation ◽  
Stem Cell Transplantation ◽  
Maintenance Therapy ◽  
Cell Transplantation ◽  
Hematopoietic Stem Cell ◽  
Autologous Transplantation ◽  
Hematopoietic Stem ◽  
Free Treatment

Abstract Though a large number of studies have confirmed that large dose chemotherapy combined with autologous transplantation can improve the OS and PFS in patients with multiple myeloma, the suitable time for transplantation is not yet conclusive. The impact of treatment depth on survival and the essentiality of maintenance therapy after autologous transplantation because of the maintenance-related side effects is also inconclusive. To evaluate the efficacy of autologous hematopoietic stem cell transplantation (ASCT) in the treatment of multiple myeloma (MM), the effects of transplantation timing, depth of treatment and maintenance therapy on survival in patients with multiple myeloma (MM). The data of 111 patients with multiple myeloma who received autologous hematopoietic stem cell transplantation (ASCT) from April 30, 2004 to June 30, 2015 were retrospectively analyzed. The median follow-up period was 31 (6-139) months. 109 of the 111 patients successfully underwent hematopoietic reconstruction,2 patients died of transplantation-related mortality. The overall response rates(ORR)rate increased from 82.9%(92/111)at pre-ASCT to 91.9%(102/111)at post-ASCT. The median progress free survival(PFS)was 50 months. The median overall survival(OS)was not reached. The median PFS and median OS in the sequential transplantation group were significantly better than those in the non sequential transplantation group (86 months vs33 months, P=0.001,not reached vs 43 months, P=0.000).The median PFS of patients achieving a nCR at pre-ASCT was longer than those not achieving a nCR group (62 months vs 34 months, P=0.023).OS showed any significance(not reached vs 47 months, P=0.094).The median PFS of patients achieving a nCR at post-ASCT was longer than those not achieving a nCR group (54 months vs 26 months, P=0.004).OS showed any significance(not reached vs 53 months, P=0.128).Regarding maintenance therapy:the group of patients achieving post-ASCT nCR:The median PFS of patients with maintenance therapy was longer than those without maintenance treatment(86 months vs 33 months, P=0.009).The median OS in maintenance therapy group was not reached,the median OS in the maintenance free treatment group was 47 months (P=0.004).The group of patients achieving less than nCR at post-ASCT:In the maintenance group, the median PFS was 26 months,the median PFS for maintenance free treatment group was 9 months (P=0.518).The median OS of patients with maintenance therapy was longer than those without maintenance treatment(53 months vs 28 months, P=0.011). Autologous transplantation after induction chemotherapy, with maintenance therapy is the preferred treatment for patients with MM.The depth of treatment has a great influence on the survival time of patients,Patients with nCR at any time during the therapy (pre-ASCT,post-ASCT) had longer OS.Maintenance therapy is associated with an extended OS, no matter whether a nCR is reached or not at post-ASCT. Disclosures No relevant conflicts of interest to declare.

Six Years of Experience and Outcome with Maintenance Therapy with Very Low Dose Thalidomide after Auto-SCT in Multiple Myeloma

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 5208-5208
Author(s):  
Vincenzo Mettivier ◽  
Luca Pezzullo ◽  
Stefano Rocco ◽  
Olimpia Finizio ◽  
Pellegrino Musto ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Overall Survival ◽  
Maintenance Therapy ◽  
Low Dose ◽  
Autologous Transplantation ◽  
Haematological Toxicity ◽  
New Drugs ◽  
Cell Leukaemia ◽  
High Dose

Abstract New drugs and high dose therapy with auto-transplantation (auto-SCT) has improved prognosis of multiple myeloma (MM). New drugs are promising in upfront therapy while the role of maintenance is still debated. Thalidomide (thal) is an active drug in the treatment of myeloma, and is been investigated as first line therapy, the limit of this drug is the toxicity dependent dose and this determines a poor compliance. It could be useful in the control of minimal residual disease. We used low dose of thal as maintenance after autologous transplantation in patient with MM from January 2002 and here we bring our experience after six years of observation. From January 2002 to August 2008 17 patients (8 males and 9 females) with MM have been treated in our institution. Median age was 59,5 years (range 48–72). 10 were IgG, 3 IgA, 3 light chains and 1 plasma-cell leukaemia. Treatment was 4 cycles of VAD regimen followed by auto-SCT. 4/17 performed double auto-SCT. Three months after SCT these patients has begun the maintenance with thal 50 mg/die, to start thal maintenance 9 patients were in CR, 5 in PR and 3 in resistant disease and the median somministration of thal has been of 12 months (range 3–24 months). Median follow up from the beginning of maintenance therapy was 40 months (range 4–76) with 11/17 (64%) patients in CR or stable disease, with progression free survival (PFS) and overall survival (OS) projected at 75 months respectively of 53% and 51% from to start thal. In our experience we have observed a neurological toxicity (grade I–III) in the 65% of the patients but only 4 have had to suspend the treatment; a haematological toxicity of grade I in the 55% of the patients that have not behaved interruption of the treatment and finally in any case we have documented thrombotic episodes. Finally we have compared this group of patients with another group (18 patients) with the same clinical characteristics that we have observed in the same period but that have not effected maintenance with thal. In this last group 13/18 patients (72%) relapsed with median follow-up of 36 months (range 14–75) and median PFS and OS of 16 and 30 months respectively. The difference between the 2 groups is statistically significant for PFS (p: 0.003) and OS (p: 0.04). The median overall survival observed after progression, in the two groups, has been of 13 months in thal group and 17 months in the group of patients that have not effected the maintenance, this difference is not statistically different (p:0.06). In conclusion in 6 years of observation our experience has shown, even if the number of the patients is small, that maintenance with low doses of thal, after auto-transplantation, it not only has a good compliance but it improves the PFS and OS in this cohort and it doesn’t worsen the OS from the relapse.

scholarly journals Maintenance therapy in multiple myeloma

2016 ◽  
Vol 8 (2) ◽  
pp. 71-79 ◽  
Author(s):  
Prerna Mewawalla ◽  
Abhishek Chilkulwar
Keyword(s):  
Multiple Myeloma ◽  
Overall Survival ◽  
Maintenance Therapy ◽  
Residual Disease ◽  
Autologous Transplantation ◽  
Progression Free Survival ◽  
Complete Response ◽  
Novel Agents ◽  
Free Survival ◽  
Incurable Disease

Despite recent advances, multiple myeloma remains an incurable disease. Induction therapy followed by autologous transplantation has become the standard of care. The idea of maintenance therapy in multiple myeloma is not new. Starting with chemotherapy in 1975, to interferon in 1998, to novel agents recently, a multitude of agents have been explored in patients with multiple myeloma. In spite of the novel agents, multiple myeloma continues to be an incurable disease with the progression-free survival after autologous transplant rarely exceeding 3 years. The goal of using maintenance therapy has been to improve the outcomes following autologous transplantation by increasing the progression-free survival, deepening remissions and perhaps increasing overall survival. It has been shown that patients with a stringent complete response (CR) have a better outcome [Kapoor et al. 2013]. It is becoming increasingly common to check minimal residual disease (MRD) as a means of assessing depth of response. It has also been shown that patients with no MRD have not only a better progression-free survival but also a better overall survival compared with patients who are MRD positive. This makes it even more important to find agents for maintenance therapy, which can further deepen and maintain responses. Here, we present a comprehensive review of the agents studied as maintenance for multiple myeloma and their efficacy, both in terms of overall survival, progression-free survival and toxicity.

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