Journal article
Impact of bortezomib-based versus lenalidomide maintenance therapy on outcomes of patients with high-risk multiple myeloma
Cancer, Vol.129(14), pp.2179-2191
07/15/2023
DOI: 10.1002/cncr.34778
PMCID: PMC10516285
PMID: 37021929
Abstract
Lenalidomide maintenance after autologous stem cell transplant (ASCT) in multiple myeloma (MM) results in superior progression-free survival and overall survival. However, patients with high-risk multiple myeloma (HRMM) do not derive the same survival benefit from lenalidomide maintenance compared with standard-risk patients. The authors sought to determine the outcomes of bortezomib-based maintenance compared with lenalidomide maintenance in patients with HRMM undergoing ASCT.
In total, the authors identified 503 patients with HRMM who were undergoing ASCT within 12 months of diagnosis from January 2013 to December 2018 after receiving triplet novel-agent induction in the Center for International Blood and Marrow Transplant Research database. HRMM was defined as deletion 17p, t(14;16), t(4;14), t(14;20), or chromosome 1q gain.
Three hundred fifty-seven patients (67%) received lenalidomide alone, and 146 (33%) received bortezomib-based maintenance (with bortezomib alone in 58%). Patients in the bortezomib-based maintenance group were more likely to harbor two or more high-risk abnormalities and International Staging System stage III disease (30% vs. 22%; p = .01) compared with the lenalidomide group (24% vs. 15%; p < .01). Patients who were receiving lenalidomide maintenance had superior progression-free survival at 2 years compared with those who were receiving either bortezomib monotherapy or combination therapy (75% vs. 63%; p = .009). Overall survival at 2 years was also superior in the lenalidomide group (93% vs. 84%; p = .001).
No superior outcomes were observed in patients with HRMM who received bortezomib monotherapy or (to a lesser extent) in those who received bortezomib in combination as maintenance compared with lenalidomide alone. Until prospective data from randomized clinical trials are available, post-transplant therapy should be tailored to each patient with consideration for treating patients in clinical trials that target novel therapeutic strategies for HRMM, and lenalidomide should remain a cornerstone of treatment.
Details
- Title: Subtitle
- Impact of bortezomib-based versus lenalidomide maintenance therapy on outcomes of patients with high-risk multiple myeloma
- Creators
- Naresh Bumma - James Cancer Center, Ohio State Medical Center, Columbus, Ohio, USABinod Dhakal - Medical College of WisconsinRaphael Fraser - Medical College of WisconsinNoel Estrada-Merly - Medical College of WisconsinKenneth Anderson - Dana-Farber Cancer InstituteCésar O Freytes - The University of Texas Health Science Center at San AntonioGerhard C Hildebrandt - University of KentuckyLeona Holmberg - Fred Hutch Cancer CenterMaxwell M Krem - Division of Hematology/BMT, Kansas City Veterans Affairs Medical Center, Kansas City, Missouri, USACindy Lee - Royal Adelaide HospitalLazaros Lekakis - University of Miami HospitalHillard M Lazarus - Case Western Reserve UniversityHira Mian - McMaster UniversityHemant S Murthy - Mayo Clinic in FloridaSunita Nathan - Rush University Medical CenterTaiga Nishihori - Moffitt Cancer CenterRicardo Parrondo - Blood and Marrow Transplantation Program, Division of Hematology-Oncology, Mayo Clinic, Jacksonville, Florida, USASagar S Patel - University of UtahMelhem Solh - Northside HospitalChristopher Strouse - University of IowaDavid H Vesole - Hackensack University Medical CenterShaji Kumar - Hematology/Oncology, Mayo Clinic, Rochester, Minnesota, USAMuzaffar H Qazilbash - The University of Texas MD Anderson Cancer CenterNina Shah - University of California, San FranciscoAnita D'Souza - Medical College of WisconsinSurbhi Sidana - Stanford Health Care
- Resource Type
- Journal article
- Publication Details
- Cancer, Vol.129(14), pp.2179-2191
- DOI
- 10.1002/cncr.34778
- PMID
- 37021929
- PMCID
- PMC10516285
- NLM abbreviation
- Cancer
- ISSN
- 0008-543X
- eISSN
- 1097-0142
- Grant note
- National Institute of Allergy and Infectious Diseases N00014-20-1-2832 / Office of Naval Research U24CA076518 / NCI NIH HHS NHLBI NIH HHS HHSH250201700006 C / HRSA HHS Stanford University N00014-20-1-2705 / Office of Naval Research
- Language
- English
- Electronic publication date
- 04/06/2023
- Date published
- 07/15/2023
- Academic Unit
- Hematology, Oncology, and Blood & Marrow Transplantation; Internal Medicine
- Record Identifier
- 9984386255502771
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