Continuous induction with lenalidomide/dexamethasone versus autologous stem cell transplantation in newly diagnosed multiple myeloma: A case for response-adapted approach Journal Article
| Authors: | Lahoud, O. B.; Landau, H.; Nguyen, J.; Devlin, S.; Lendvai, N.; Weltz, J.; Ayorinde, T.; Chung, D. J.; Lesokhin, A. M.; Kewalramani, T.; Korde, N.; Mailankody, S.; Landgren, O.; Giralt, S.; Comenzo, R. L.; Hassoun, H. |
| Article Title: | Continuous induction with lenalidomide/dexamethasone versus autologous stem cell transplantation in newly diagnosed multiple myeloma: A case for response-adapted approach |
| Abstract: | Although upfront autologous stem cell transplantation (ASCT) generally improves progression-free survival (PFS) in newly diagnosed multiple myeloma (NDMM), the overall survival (OS) benefit and optimal timing of ASCT are not well established. Patients with early response may be able to safely continue induction and avoid ASCT without compromised outcomes. We report an extended follow-up analysis of a phase 2 trial that randomized transplant-eligible patients with NDMM who responded to induction (50/65 patients) to continued induction or ASCT; median follow-up was 8.0 years. Patients had similar 8-year PFS (55% vs. 43%), 8-year OS (83% vs. 72%), and rates of at least very good partial response (72% vs. 84%) whether continuing induction of lenalidomide and dexamethasone (Ld arm) or receiving ASCT (Ld + ASCT arm) (p = 0.5). Notably, over 50% of patients receiving continuous Ld had PFS of 5–10 years. These results suggest the need for prospective trials incorporating response-adapted therapeutic approaches to NDMM.STATEMENT OF PRIOR PRESENTATION Presented in abstract form (interim analysis) at the 56th annual meeting of the American Society of Hematology (San Francisco, CA, 6 December 2014) and at the 57th annual meeting of the American Society of Hematology (Orlando, FL, 3 December 2015). © 2022 Informa UK Limited, trading as Taylor & Francis Group. |
| Keywords: | adult; controlled study; treatment response; aged; fracture; major clinical study; overall survival; lenalidomide; neutropenia; cancer combination chemotherapy; diarrhea; drug safety; hypophosphatemia; follow up; antineoplastic agent; cancer diagnosis; prospective study; prospective studies; low drug dose; melanoma; progression free survival; bortezomib; infection; multiple cycle treatment; multiple myeloma; phase 2 clinical trial; anemia; leukopenia; randomized controlled trial; thrombocytopenia; antineoplastic combined chemotherapy protocols; cytogenetics; cyclophosphamide; dexamethasone; melphalan; autologous stem cell transplantation; stem cell transplantation; hematopoietic stem cell transplantation; acute lymphoblastic leukemia; febrile neutropenia; hyperglycemia; lymphocytopenia; alanine aminotransferase; alkaline phosphatase; aspartate aminotransferase; bilirubin; acute kidney failure; hypokalemia; hyponatremia; disease severity; myelodysplastic syndrome; fluorescence in situ hybridization; acetylsalicylic acid; carcinoma; beta 2 microglobulin; second cancer; echocardiography; rectum carcinoma; heart left ventricle ejection fraction; immunoglobulin kappa chain; immunoglobulin lambda chain; granulocyte colony stimulating factor; bilirubin blood level; transplantation, autologous; adverse drug reaction; induction chemotherapy; platelet count; low molecular weight heparin; autotransplantation; demographics; acute myeloid leukemia; procedures; metastatic colon cancer; long term survival; Common Terminology Criteria for Adverse Events; intention to treat analysis; humans; human; male; female; article; lactate dehydrogenase a; absolute neutrophil count; response-adapted therapy; ecog performance status; continuous induction; metastatic colon carcinoma |
| Journal Title: | Leukemia and Lymphoma |
| Volume: | 63 |
| Issue: | 9 |
| ISSN: | 1042-8194 |
| Publisher: | Taylor & Francis Group |
| Date Published: | 2022-01-01 |
| Start Page: | 2126 |
| End Page: | 2135 |
| Language: | English |
| DOI: | 10.1080/10428194.2022.2062347 |
| PUBMED: | 35648041 |
| PROVIDER: | scopus |
| PMCID: | PMC9703606 |
| DOI/URL: | |
| Notes: | Article -- Export Date: 1 November 2022 -- Source: Scopus |
