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Lenalidomide vs bortezomib maintenance choice post-autologous hematopoietic cell transplantation for multiple myeloma

Bone Marrow Transplantation volume 53, pages 701–707 (2018)Cite this article

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Abstract

Maintenance therapy post-autologous hematopoietic cell transplantation (AHCT) with either lenalidomide or bortezomib for multiple myeloma (MM) have separately been shown to improve progression-free survival (PFS), but have never been directly compared. We performed a retrospective study to investigate progression-free and overall survival outcomes and toxicities of lenalidomide maintenance therapy compared with bortezomib maintenance in MM patients post-AHCT. This study included 156 patients who received post-AHCT lenalidomide or bortezomib maintenance therapy for MM. The primary outcome was PFS. Ninety-two patients received lenalidomide maintenance and 64 received bortezomib maintenance post-AHCT. By multivariable analysis, maintenance therapy choice and cytogenetics risk did not impact PFS or OS. Staging by International Staging System and pre-maintenance disease response were the greatest predictors for PFS. Treatment-related toxicities were as anticipated with 5.4% of patients receiving maintenance lenalidomide experiencing secondary primary malignancies (SPMs) compared with 3% for bortezomib. These findings suggest there were no differences in PFS or OS between lenalidomide and bortezomib maintenance therapy options for post-transplantation MM patients. These data should be validated in a larger, prospective cohort to determine if maintenance choice should be guided by side effect profile and patient anticipated tolerance rather than by disease biology alone.

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Authors and Affiliations

  1. Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA

    Jennifer Huang

  2. Division of Biostatistics and Quantitative Sciences, Vanderbilt University Medical Center, Nashville, TN, USA

    Sharon Phillips

  3. Division of Hematology/Oncology, Vanderbilt University Medical Center, Nashville, TN, USA

    Michael Byrne, Wichai Chinratanalab, Brian G. Engelhardt, Stacey A. Goodman, Shelton L. Harrell, Madan Jagasia, Adetola Kassim, Kyle T. Rawling, Bipin N. Savani, Salyka Sengsayadeth & R. Frank Cornell

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Correspondence to R. Frank Cornell.

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Huang, J., Phillips, S., Byrne, M. et al. Lenalidomide vs bortezomib maintenance choice post-autologous hematopoietic cell transplantation for multiple myeloma. Bone Marrow Transplant 53, 701–707 (2018). https://doi.org/10.1038/s41409-018-0177-6

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