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Impact of Chemotherapy Based Induction Using Dexamethasone, Cisplatin, Doxorubicin, Cyclophosphamide and Etoposide (DPACE) Versus Novel Agent Induction in Patients Undergoing Tandem Autologous Stem Cell Transplantation (ASCT) for Multiple Myeloma (MM)
Abstract   Open access

Impact of Chemotherapy Based Induction Using Dexamethasone, Cisplatin, Doxorubicin, Cyclophosphamide and Etoposide (DPACE) Versus Novel Agent Induction in Patients Undergoing Tandem Autologous Stem Cell Transplantation (ASCT) for Multiple Myeloma (MM)

Kalyan Nadiminti, Christopher Strouse, M Hasib Sidiqi, Lindsay Dozeman, Sarah L. Mott, Allyson Schultz, Jillna Claus, Praveen Vikas, Umar Farooq, Michael Tomasson, …
Biology of blood and marrow transplantation, Vol.25(3), pp.S399-S400
03/2019
DOI: 10.1016/j.bbmt.2018.12.813
url
https://doi.org/10.1016/j.bbmt.2018.12.813View
Published (Version of record) Open Access

Abstract

Many studies showed that novel agent based regimens result in superior response rates and depth. Recommended practice prior to ASCT in TE, NDMM is novel induction therapy. While one CIBMTR study did not find an impact of intensity of induction therapy on overall outcomes, several other studies showed a significant impact. The value of induction therapy and response in the context of tandem ASCT using novel conditioning is not well studied. All sequential patients who received a planned tandem ASCT at our center between 2012 and 2015 were included in the analysis. We compared outcomes of patients who received novel induction based therapy, followed by DPACE mobilization with those who received DPACE alone as induction. Time was calculated from date of initial transplant to relapse or death due to any cause for PFS, and to death due to any cause for OS. The effect of clinical characteristics on outcomes was evaluated using Cox regression models. A time-dependent covariate was utilized for maintenance therapy. 135 patients were included in the analysis. 39 patients received only DPACE and 96 received novel induction. 84 were male. Median age is 58 years (range 37-71).Conditioning regimen consisted of bortezomib, thalidomide, dexamethasone and melphalan (VTD-Mel) in all except 4 patients, who received melphalan only. 56% were classified as high risk by FISH. 43%, 26% and 25% received 2 years, 1 year and < 1 year of maintenance therapy. There was no difference in PFS or OS between the groups who received DPACE only versus the novel agent group. Best responses achieved at the time of transplant were 5% and 71% PR and CR, in DPACE group and 18% and 60% in the novel induction group, respectively. For the overall cohort, 5 year PFS and OS were 58% and 65%, respectively. Increasing age conferred poorer PFS and OS (both p<0.01). Maintenance therapy was found to be associated with PFS. The risk of relapse or death increased nearly 4 times (p<0.01) when maintenance was not received. This study shows that after a planned tandem ASCT, there was no difference in OS at median follow up time of 33 months between patients who received 1 cycle of DPACE and those who received novel agent induction. Similarly, high risk and standard risk cytogenetics patients had similar OS. Responses with DPACE were lower compared to novel induction regimen, as was observed in previous studies. Although this study does not change the practice of induction, it is an important observation that the tandem ASCT followed by maintenance therapy may overcome the poor prognosis of high risk cytogenetics. The role of duration and intensity of induction therapy in tandem ASCT needs to further investigated.

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