"The results of this study are based on our own clinical experience. It is not a prospective study, but a retrospective analysis."
Dr. Meral Beksac
To view the video full screen, click on the small button next to the volume control in the lower right hand corner.
 Amplitude of Response, Early Mobilization (M) and Pre-Autologous Transplant (ASCT) Use of Bortezomib (V) and/or Thalidomide (T) Are Predictors of Longer Progression Free (PFS) and/or Overall Survival (OS) in Myeloma. Session Type: Publication Only
Meral Beksac, Ender Soydan, Vildan Ozkocaman, Pervin Topcuoglu, Berna Evranos, Merih Kizil, Aynur U. Bilgin, Mutlu Arat, Muhit Ozcan, Onder Arslan, Gunhan Gurman, Osman Ilhan Hematology, Ankara University, Ankara, Turkey
Impact of complete response on outcome is a subject of ongoing debate. Aim: In this retrospective analysis of all myeloma-ASCT patients transplanted between 1999- 2007 (n:116) in our center with a minimum 3 mo followup (n:91) and a disease status available at the time of M (n:66) were analyzed for evaluation of the impact of response at M, preASCT, postASCT; the preASCT use of novel agents ; timing of M (>,< 6 mo) and ASCT (>,< 12 mo) on response and survival. 91 patients aged 33-66(med:52) were included. Induction (VAD/ T D/ MP: 72/8/10) was given for a median of 8.3 mo pre M. 45 patients received additional chemo(n:3), (V :1, T :17, both:10) or none(n:41) untill ASCT with Melphalan (200 mg/sq.m) within 12 months (54%). For < 90% response, V/T alone or in combination was given during the postASCT period and/or received a second ASCT/NMA. SPSS version 11.0 was used for Kaplan Meier survival and Chi Square analysis. Results: Patient characteristics between early vs late M or ASCT, novel agent (+) vs (-) were similar .>90% response rates at different time points (M / preASCT/ postASCT) were: 54.5%, 59.7% and 61.3%. One third of patients could be mobilized early. Response rates of early and late M were: 73.6% vs 46.6% (p=0.04). Novel agents were used less frequently in early M patients (22% vs 40%). Among all analyzed, only response during M, timing of M and use of V/T were found to be influential on PFS and/or OS. Evaluation of factors (b2mg,ISS,age,chemo line)on response during M revealed only late M to be associated with less response (p=0.05). Among early M patients, amplitude of response (>90% vs others) did not prolong PFS or OS. However, among patients who were mobilized later, achievement of >90% response prolonged PFS at 3 yr (100% vs 85%,p=0.03) at 5 yr (100% vs 44%,p=0.03) (Fig.1). The impact of response to induction, on OS was also observed in all patients irrespective of M time (3 yr: 93% vs 83%, 5 yr: 80% vs 55%, p=0.02). Comparison of patients who had received at least one novel agent during the preASCT, compared to those not, revealed an OS prolongation (3yr:100% vs 81%; 5yr: 81% vs 56%, p=0.03). (Fig. 2). Patients who had received a novel agent were mobilized at similar times but were transplanted later (9/27 vs 28/42, p= 0.01). Although there was a trend, novel agents did not influence PFS or response rate significantly at any time point. Conclusions: In this retrospective analysis, we were able to demonstrate a benefical effect of response amplitude, earlier (<6 months) mobilization,and pre ASCT use of novel agents. Early M but not late M masks any influence of chemosensitivity to induction. Late M which is associated with less response contributes to the impact of response on survival.
Abstract #5096 appears in Blood, Volume 110, issue 11, November 16, 2007
Keywords: Induction Chemotherapy|Complete Remission|Autologous Stem Cell Collection
Disclosure: Research Funding: Janssen Cilag. Membership Information: Janssen Cilag and Pharmion.
Session Info: Publication Only