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KMID : 0366220130480030198
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Korean Journal of Hematology
2013 Volume.48 No. 3 p.198 ~ p.205
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The impact of novel therapeutic agents before and after frontline autologous stem cell transplantation in patients with multiple myeloma
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Min Chang-Ki
Lee Sung-Eun
Yahng Seung-Ah
Cho Byung-Sik
Eom Ki-Seong
Kim Yoo-Jin
Kim Hee-Je
Lee Seok
Cho Seok-Goo
Kim Dong-Wook
Lee Jong-Wook
Min Woo-Sung
Park Chong-Won
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Abstract
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Background: Novel agents (NAs) such as thalidomide and bortezomib have been administered in com-bination with autologous stem-cell transplantation (ASCT) to effectively treat multiple myeloma (MM). However, whether NAs perform better as induction treatments prior to transplantation, or as post-transplant maintenance therapies remains unclear.
Methods: We retrospectively analyzed 106 consecutive patients with MM who underwent ASCT within 1 year of diagnosis as first-line therapy.
Results: Eighty-seven (82.1%) patients received NAs before ASCT, whereas 68 (64.2%) received NAs after ASCT. NAs were administered to each patient as follows: before ASCT alone (N=29, 27.4%), after ASCT alone (N=10, 9.4%) or both before and after ASCT (N=58, 54.7%). High-quality rates before and after ASCT were significantly higher for patients who received NAs as induction treatment compared to those who did not receive pre-transplant NAs. At a median follow-up of 37.9 months, the 3-year progression-free survival (PFS) and overall survival (OS) rates were 42.8% and 70.2%, respectively. The PFS and OS were significantly higher in patients with NAs as post-transplant maintenance treatment (P=0.03 and P=0.04, respectively), but not in those with NAs as pre-transplant induction treatment. The PFS of patients with NAs before and after ASCT was higher than that of the patients with NAs as induction therapy alone (P=0.05). Age, serum β2-micro-globulin level, complete response after ASCT, and NA use post-ASCT independently pre-dicted survival outcomes.
Conclusion: These findings suggest that integration of NAs post-ASCT could benefit patients with MM undergoing ASCT. Induction therapy using NAs also improves high-quality response rates before and after ASCT.
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KEYWORD
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Multiple myeloma, Novel agents, Autologous stem cell transplantation, Induction and maintenance treatment
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