PROGNOSTIC FACTORS AND TREATMENT OUTCOME OF TRANSPLANT-ELIGIBLE MYELOMA PATIENTS RECEIVING THE STAGED APPROACH, PAD OR VTD AS INDUCTION THERAPY IN HONG KONG

    loading  Checking for direct PDF access through Ovid

Abstract

Since 2005, 91 myeloma transplant-eligible patients received three induction regimens containing frontline bortezomib including the staged approach (n = 25), PAD (bortezomib, adriamycin, dexamethasone) (n = 31) or VTD (bortezomib, thalidomide, dexamethasone) (n = 35). In the staged approach, myeloma patients first received three cycles of VAD (vincristine, adriamycin, dexamethasone). If their paraprotein reduction was ≥75%, they would proceed to receive autologous stem cell transplantation (ASCT) (n = 11). If their response was <75%, they would receive four additional cycles of VTD, and then ASCT (n = 14).(Chim et al, 2010) On the other hand, in those induced with PAD or VTD, ASCT were carried out if they achieved >50% response after 4 cycles of induction. All patients received thalidomide maintenance for 2 years after ASCT. There were 50 (54.9%) males and 41 (45.1%) females with a median age of 55 years (range: 33-65 years). There were 29 patients with International Staging System (ISS) stage I, 18 stage II and 43 stage III disease. There were 40 (44%) IgG, 25 (27.5%) light chain, 15 (16.5%) IgA, seven (7.7%) IgD and four (4.4%) non-secretary myeloma cases. The overall CR rate/nCR rate and VGPR rates were 37.4% and 72.5% after induction therapy, and 62.6% and 82.4% after ASCT. Induction CR/nCR rate was not impacted by regimen (P = 0.268), ISS (P = 0.795), gender (P = 0.518) but favorably impacted by light cchain isotype (P = 0.017). The 5-year OS and event-free (EFS) survivals were 66% and 45.1%. There was no difference between the induction CR/nCR rate (P = 0.268), EFS (0.516) or OS (P = 0.661) of patients induced by these three regimens. Multivariate analysis incorporating age, gender, regimen, ISS, isotype, response after induction and response after ASCT showed that ISS and CR/nCR after ASCT were factors impacting OS, and ISS and CR/nCR after induction were factors impacting EFS. Of the 27 patients with FISH investigation for del(13), t(4;14), del(17p) and t(14;16), there was no difference in OS and EFS for those (n = 9) with and without (n = 18) these aberrations. In conclusion, these three induction regimens produced comparable and favorable outcomes in Chinese myeloma patients. The unfavorable outcome with ISS stage III disease persisted despite upfront use of bortezomib.

Related Topics

    loading  Loading Related Articles