; Hennemann, Burkhard ; Metzner, Bernd ; Knop, Stefan ; Adler-Reichel, Sigrid ; Gerecke, Christian ; Wandt, Hannes ; Bentz, Martin ; Bruemmendorf, Tim Hendrik ; Hentrich, Marcus ; Pfreundschuh, Michael ; Wolf, Hans-Heinrich ; Sezer, Orhan ; Bargou, Ralf ; Jung, Wolfram ; Trümper, Lorenz ; Hertenstein, Bernd ; Heidemann, Else ; Bernhard, Helga ; Lang, Nicola ; Frickhofen, Norbert ; Hebart, Holger ; Schmidmaier, Ralf ; Sandermann, Andreas ; Dechow, Tobias ; Reichle, Albrecht ; Schnabel, Brigitte ; Schäfer-Eckart, Kerstin ; Langer, Christian ; Gramatzki, Martin ; Hinke, Axel ; Emmerich, Bertold ; Einsele, Hermann | Item type: | Article | ||||
|---|---|---|---|---|---|
| Journal or Publication Title: | Haematologica | ||||
| Publisher: | Ferrata-Storti Foundation | ||||
| Place of Publication: | PAVIA | ||||
| Volume: | 101 | ||||
| Number of Issue or Book Chapter: | 11 | ||||
| Page Range: | pp. 1398-1406 | ||||
| Date: | 2016 | ||||
| Institutions: | Medicine > Lehrstuhl für Innere Medizin III (Hämatologie und Internistische Onkologie) | ||||
| Identification Number: |
| ||||
| Keywords: | STEM-CELL TRANSPLANTATION; THALIDOMIDE PLUS DEXAMETHASONE; ELDERLY-PATIENTS; AUTOLOGOUS TRANSPLANTATION; BORTEZOMIB INDUCTION; THERAPY; LENALIDOMIDE; MELPHALAN; MAINTENANCE; COMBINATION; | ||||
| Dewey Decimal Classification: | 600 Technology > 610 Medical sciences Medicine | ||||
| Status: | Published | ||||
| Refereed: | Yes, this version has been refereed | ||||
| Created at the University of Regensburg: | Yes | ||||
| Item ID: | 42828 |

Abstract
Autologous transplantation is controversial for older patients with multiple myeloma. The role of age-adjusted high-dose melphalan and the impact of induction chemotherapy cycles is still unclear. A total of 434 patients aged 60-70 years were randomly assigned to 4 cycles of standard anthracycline-based induction chemotherapy or no induction. For all patients, double autologous transplantation ...

Abstract
Autologous transplantation is controversial for older patients with multiple myeloma. The role of age-adjusted high-dose melphalan and the impact of induction chemotherapy cycles is still unclear. A total of 434 patients aged 60-70 years were randomly assigned to 4 cycles of standard anthracycline-based induction chemotherapy or no induction. For all patients, double autologous transplantation after melphalan 140 mg/m(2) (MEL140) was planned. The primary end point was progression-free survival. Of 420 eligible patients, 85% received a first transplant and 69% completed double transplantation. Treatment duration was short with a median of 7.7 months with induction chemotherapy cycles and 4.6 months without induction. On an intention-to-treat basis, median progression-free survival with induction chemotherapy cycles (207 patients) was 21.4 months versus 20.0 months with no induction cycles (213 patients) (hazard ratio 1.04, 95% confidence interval 0.84-1.28; P= 0.36). Per protocol, progression-free survival was 23.7 months versus 23.0 months (P= 0.28). Patients aged 65 years or over (55%) did not have an inferior outcome. Patients with low-risk cytogenetics [absence of del17p13, t(4; 14) and 1q21 gains] showed a favorable overall survival and included the patients with sustained first remission. MEL140 was associated with a low rate of severe mucositis (10%) and treatment-related deaths (1%). Based on hazard ratio, the short treatment arm consisting of mobilization chemotherapy and tandem MEL140 achieved 96% of the progression-free survival, demonstrating its value as an independent component of therapy in older patients with multiple myeloma who are considered fit for autologous transplantation.
Metadata last modified: 17 Mar 2020 12:06
Altmetric