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Multiple myeloma, gammopathies

Outcomes of maintenance therapy with lenalidomide or bortezomib in multiple myeloma in the setting of early autologous stem cell transplantation

Leukemia volume 32, pages 712–718 (2018)Cite this article

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Abstract

Post-transplant maintenance is widely used in multiple myeloma (MM); however, there is a lack of data on real-world outcomes. We have analyzed 577 patients with newly diagnosed MM undergoing early auto-transplantation between 2010 and 2015. A total of 341, 132 and 104 patients received no, lenalidomide (Len) or bortezomib (Bort) maintenance, respectively. Patients receiving Len or Bort maintenance had a higher incidence of high-risk cytogenetics by fluorescence in situ hybridization (31% (Len) vs 58% (Bort) vs 8% (No); P<0.001). Len maintenance led to a superior progression-free survival (PFS) compared with no maintenance (median, 37 vs 28 months, respectively; P=0.002; adjusted hazard ratio 0.48 (95% CI, 0.35–0.66)), including in subgroups with ISS stage III disease (median, 40 vs 24 months; P=0.008) and high-risk cytogenetics (median, 27 vs 16 months; P=0.032). Bort maintenance did not confer PFS benefit for the entire cohort, but improved PFS in the high-risk cytogenetic subgroup (median, 28 vs 16 months; P=0.035). Discontinuation due to toxicity was seen in 17 and 7% of patients receiving Len or Bort maintenance, respectively. Our results indicate that post-transplant maintenance with Len or Bort is well tolerated in clinical practice and improves PFS in high-risk subgroups of MM patients.

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Authors and Affiliations

  1. Division of Hematology, Mayo Clinic, Rochester, MN, USA

    R Chakraborty, E Muchtar, S K Kumar, F K Buadi, D Dingli, A Dispenzieri, S R Hayman, W J Hogan, P Kapoor, M Q Lacy, N Leung, R Warsame, T Kourelis, W Gonsalves & M A Gertz

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  1. R Chakraborty
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  2. E Muchtar
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  3. S K Kumar
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Correspondence to M A Gertz.

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Competing interests

MAG: research funding (Amgen, Celgene, Prothena, Ionis) and Honoraria (Celgene); AD: research funding (Prothena, Takeda, Celgene, Pfizer, Alnylam); PK: research support (Takeda, Celgene, Amgen); DD: consulting (Takeda, Janssen) and research support (Karyopharm Therapeutics); SKK: honoraria (Kesios Therapeutics, Noxxon Pharma, Skyline Diagnostics), consulting (Abbvie, Amgen, Bristol-Myers-Squibb, Janssen, Takeda) and research funding (Abbvie, Celgene, Janssen, Merck, Novartis, Sanofi, Takeda). The remaining authors declare no conflict of interest.

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Chakraborty, R., Muchtar, E., Kumar, S. et al. Outcomes of maintenance therapy with lenalidomide or bortezomib in multiple myeloma in the setting of early autologous stem cell transplantation. Leukemia 32, 712–718 (2018). https://doi.org/10.1038/leu.2017.256

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