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Exploratory analysis of intensified conditioning as first line treatment for patients with high risk multiple myeloma.
- Source :
-
Hematological oncology [Hematol Oncol] 2020 Oct; Vol. 38 (4), pp. 517-522. Date of Electronic Publication: 2020 Jul 29. - Publication Year :
- 2020
-
Abstract
- Multiple myeloma has extremely heterogeneous outcomes. Among prognostic factors, t(4;14) and del(17p) are rare oncogenic events associated with very poor prognosis. In an exploratory case-control study, we compared the combination of Busulfan-Melphalan or TBI-Melphalan with high dose Melphalan as a conditioning regimen in a series of 48 patients with del(17p) or t(4;14). These regimens were preceded by a Bortezomib-containing induction. Progression-free survival (PFS) was the primary endpoint whereas overall survival (OS) and complete response (CR) rate were the secondary endpoints. Twenty consecutive cases of high-risk myeloma received a reinforced conditioning regimen of Busulfan 0.8 mg/kg x4/j IV from day-6 to day-3 pre- graft (BuMel) or total body irradiation (TBI) 12 Gy (TbiMel), having received Melphalan 140 mg/m <superscript>2</superscript> at day-2 pre-graft. These cases were matched to 28 controls treated with Melphalan 200 mg/m <superscript>2</superscript> at day-2 (Mel200). After intensification ± consolidation, with a median follow-up of 6.3 years, the CR rate was higher in the BuMel/TbiMel group (65% vs 50%, P = .006). No differences were observed between both groups in terms of PFS and OS (P = .96). PFS in patients with a del(17p) mutation tended to be superior in the BuMel/TbiMel group. Our exploratory study shows that reinforcing the intensification regimen with Busulfan or TBI does not seem to improve the prognosis associated to t(4;14) and del(17p) abnormalities.<br /> (© 2020 John Wiley & Sons Ltd.)
- Subjects :
- Bortezomib administration & dosage
Busulfan administration & dosage
Combined Modality Therapy
Female
Follow-Up Studies
Humans
Male
Melphalan administration & dosage
Middle Aged
Multiple Myeloma pathology
Prognosis
Remission Induction
Retrospective Studies
Survival Rate
Transplantation, Autologous
Antineoplastic Combined Chemotherapy Protocols therapeutic use
Hematopoietic Stem Cell Transplantation mortality
Multiple Myeloma therapy
Transplantation Conditioning mortality
Whole-Body Irradiation mortality
Subjects
Details
- Language :
- English
- ISSN :
- 1099-1069
- Volume :
- 38
- Issue :
- 4
- Database :
- MEDLINE
- Journal :
- Hematological oncology
- Publication Type :
- Academic Journal
- Accession number :
- 32569436
- Full Text :
- https://doi.org/10.1002/hon.2767