Induction Therapy with Novel Agents Improves Relapse-Free Survival After Autologous Stem-Cell Transplantation in Multiple Myeloma

Multiple myeloma (MM) is still an incurable disease. Initial treatment depends on age, risk stratification and co-morbidities. High-dose therapy followed by autologous stem-cell transplantation (ASCT) is the standard of care in transplant eligible patients.

In recent years, novel agents became a promising role in newly diagnosed, relapsed myeloma as well as in maintenance treatment. Bortezomib, a proteasome inhibitor, and thalidomide or lenalidomide, immunomodulatory agents have been found to be superior to chemotherapy regimens.

121 adult patients (50 female, 71 male) with a median age of 53.5 years at diagnosis underwent autologous stem-cell transplantation at the Medical University of Vienna between June 1985 and September 2010. Median age at ASCT was 57.4 years.

46 patients received novel therapeutic agents, such as VDT (bortezomib, dexamethasone, thalidomide), Rd (lenalidomide, low dose dexamethasone) and VD (bortezomib, dexamethasone), whereas 75 patients were treated on the basis of chemotherapy schedules, e.g. VAD-based (vincristine, doxorubicin, dexamethasone).

Progression-free survival (PFS) after ASCT was 7.9 months (6,4 – 9,3, 95% CI) after treatment with chemotherapy, whereas it was increased to 21,6 months (5 – 38,1, 95% CI) after initial treatment with either bortezomib and/or thalidomide/lenalidomide (p= 0.001).

Post-induction VGPR or better was superior with new agents compared to chemotherapy, 34,1% versus 11,9%, respectively. Post-transplant VGPR or better was as high as 68% after initial therapy with novel agents prior to transplant, whereas VGPR or better was reached in 48.6% in patients receiving chemotherapy.

Novel agents significantly prolong relapse-free survival in patients eligible for autologous stem-cell transplantation. Previous studies showed improved remission duration with thalidomide or lenalidomide maintenance after ASCT. The data of maintenance therapy after ASCT at our department will be presented at the meeting.

No relevant conflicts of interest to declare.