Abstract
Prior studies have shown that myeloma patients exhibiting either genetically defined high-risk disease or plasma cell leukemia have a poor outcome with a median overall survival (OS) of ⩽3 years. Results of IFM 2005-01 and 02 suggest that relatively limited bortezomib-containing induction regimens did not produce a major survival benefit among these patients. However, results of recent studies suggest that combination therapy may benefit these patients when given early and again later in the treatment. We evaluated a combination maintenance/consolidation regimen (RVD) following autologous stem cell transplant (ASCT) for high-risk patients to evaluate the impact of this approach on outcome. Following initiation of RVD maintenance, 51% of patients achieved stringent complete response (sCR), with 96% achieving at least VGPR as best response. Median progression free survival (PFS) for all patients is 32 months with a 3-year OS of 93%. The regimen was well tolerated with no grade 3/4 neuropathy. Early ASCT followed by RVD maintenance is a promising strategy for high-risk myeloma patients and delivered excellent response rates, and promising PFS and OS.
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Jonathan Kaufman has received research support from Celgene, Novartis and Merck and served as a consultant for Celgene, Millennium, Janssen, Novartis and Onyx. Sagar Lonial has served as a consultant for Celgene, BMS, Novartis, Onyx, Sanofi and Millennium. Lawrence Boise served as a consultant for Onyx. Charise Gleason served as a consultant for Millennium. Leonard Heffner has received honoraria from Amgen, Spectrum and Pharmacyclics. The other authors declare no conflict of interest.
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AKN, JLK and SL designed the study; AKN, CG and DC analyzed the results and made the tables and figures; AKN, JLK, SL, AL, LHB, SM, LTH and DS prepared, reviewed and edited the final manuscript. All authors were fully responsible for the content.
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Nooka, A., Kaufman, J., Muppidi, S. et al. Consolidation and maintenance therapy with lenalidomide, bortezomib and dexamethasone (RVD) in high-risk myeloma patients. Leukemia 28, 690–693 (2014). https://doi.org/10.1038/leu.2013.335
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DOI: https://doi.org/10.1038/leu.2013.335
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