Autologous transplantation, consolidation, and maintenance therapy in multiple myeloma: Results of the BMT CTN 0702 Trial Journal Article

Authors: Stadtmauer, E. A.; Pasquini, M. C.; Blackwell, B.; Hari, P.; Bashey, A.; Devine, S.; Efebera, Y.; Ganguly, S.; Gasparetto, C.; Geller, N.; Horowitz, M. M.; Koreth, J.; Knust, K.; Landau, H.; Brunstein, C.; McCarthy, P.; Nelson, C.; Qazilbash, M. H.; Shah, N.; Vesole, D. H.; Vij, R.; Vogl, D. T.; Giralt, S.; Somlo, G.; Krishnan, A.
Article Title: Autologous transplantation, consolidation, and maintenance therapy in multiple myeloma: Results of the BMT CTN 0702 Trial
Abstract: PURPOSESingle-cycle melphalan 200 mg/m(2) and autologous hematopoietic cell transplantation (AHCT) followed by lenalidomide (len) maintenance have improved progression-free survival (PFS) and overall survival (OS) for transplantation-eligible patients with multiple myeloma (MM). We designed a prospective, randomized, phase III study to test additional interventions to improve PFS by comparing AHCT, tandem AHCT (AHCT/AHCT), and AHCT and four subsequent cycles of len, bortezomib, and dexamethasone (RVD; AHCT + RVD), all followed by len until disease progression.PATIENTS AND METHODSPatients with symptomatic MM within 12 months from starting therapy and without progression who were age 70 years or younger were randomly assigned to AHCT/AHCT + len (n = 247), AHCT + RVD + len (n = 254), or AHCT + len (n = 257). The primary end point was 38-month PFS.RESULTSThe study population had a median age of 56 years (range, 20 to 70 years); 24% of patients had high-risk MM, 73% had a triple-drug regimen as initial therapy, and 18% were in complete response at enrollment. The 38-month PFS rate was 58.5% (95% CI, 51.7% to 64.6%) for AHCT/AHCT + len, 57.8% (95% CI, 51.4% to 63.7%) for AHCT + RVD + len, and 53.9% (95% CI, 47.4% to 60%) for AHCT + len. For AHCT/AHCT + len, AHCT + RVD + len, and AHCT + len, the OS rates were 81.8% (95% CI, 76.2% to 86.2%), 85.4% (95% CI, 80.4% to 89.3%), and 83.7% (95% CI, 78.4% to 87.8%), respectively, and the complete response rates at 1 year were 50.5% (n = 192), 58.4% (n = 209), and 47.1% (n = 208), respectively. Toxicity profiles and development of second primary malignancies were similar across treatment arms.CONCLUSIONSecond AHCT or RVD consolidation as post-AHCT interventions for the up-front treatment of transplantation-eligible patients with MM did not improve PFS or OS. Single AHCT and len should remain as the standard approach for this population.
Keywords: chemotherapy; stem-cell transplantation; induction; superior; single; lenalidomide maintenance; bortezomib-thalidomide-dexamethasone; vcd; vtd
Journal Title: Journal of Clinical Oncology
Volume: 37
Issue: 7
ISSN: 0732-183X
Publisher: American Society of Clinical Oncology  
Date Published: 2019-03-01
Start Page: 589
End Page: 597
Language: English
ACCESSION: WOS:000460356200007
DOI: 10.1200/jco.18.00685
PUBMED: 30653422
Notes: Source: Wos
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MSK Authors
  1. Sergio Andres Giralt
    535 Giralt
  2. Heather Jolie Landau
    187 Landau