Analysis of outcome after autologous SCT in patients with newly diagnosed myeloma: comparison of different induction regimens
Shaji Kumar, M.D., David Dingli, M.D., Martha Q. Lacy, M.D., Angela Dispenzieri, M.D., Suzanne R. Hayman, M.D., S. Vincent Rajkumar, M.D., Steve Zeldenrust, M.D., John A Lust, M.D., Philip R. Greipp, M.D., Robert A.
Kyle,M.D., Dennis Gastineau, M.D., Morie A. Gertz, M.D., .Division of Hematology, Mayo Clinic, Rochester, MN, United States, 55905.
Background
Results
· Autologous stem cell transplantation (SCT) improves survival in patients (pts) with multiple myeloma (MM).
Tabl
a e 1. Bas
a el
e ine
n fe
f at
e ures at trans
r
pl
p a
l nt
a
P r ogr e s s i on Fr e e S u r v i v a l f r om Tr a n s p l a nt
VAD
Dex
De
Tha
Th l
a -Dex
p-
· We have previously demonstrated that the degree of response at transplant does not impact on the outcome of transplant.
1. 0
VA D
Char
h
ac
ar
t
ac er
e i
r st
s i
t cs
c
(n=
(n 1
= 0
1 5)
5
(n = 140)
(n = 95)
5
val
va ue
u
De x
Th a l - D e x
Vari
r abl
b e
medi
e an
medi
e an
di
P
· However, newer induction regimens such as thalidomide and dexamethasone (Thal-Dex) result in significantly higher response
0. 8
(ran
(ra g
n e)
e
(ran
r
ge)
valu
l e
rates compared to single agent dexamethasone or vincristine, doxorubicin, and dexamethasone (VAD).
Ag
A e at diagno
g sis
54.9
54. (29.
2 4
9. -
4
59 (35
3 -75.
-
2)
56.9
56. (37
3 -
7 75
- )
75
0.004*
.
l
0. 6
72.
72 2
. )
aivrv
· We examined the outcome of SCT following three different induction therapies for newly diagnosed myeloma, namely VAD,
Su
Ag
A e at tr
t anspl
sp ant
55.8
55. (30
3 -
0
59.
59 6
. (3
( 5.
5 5-
.
57.
57 4
. (37.
3 3
7. ­
3
0.005*
.
0. 4
72.
72 6
. )
75.8
. )
75.5)
single agent Dex, and Thal-Dex.
Time
m to Tran
a s
n pl
p an
a t
6.4
6. (4.
4 3
. -
5.4 (3
( .2
3 ­
*,#
5.9 (3.3-11.9)
*,
5.9 (3.3-11.9)
0. 2
(mo
(m s)
s
11.
11 4
. )
11.6
. )
Patients and Methods
Se
S r
e um M prot
o ei
e n
i
1.4 (0
( -
0 6.9
6 )
1.0
. 6
0 (0-6.9)
.9
0.8
0. (0-
0 4
- .6
. )
6
0.02**
.
0. 0
lev
le e
v l
e
0
2 04 06 08 0
1 0 0
1 2 0
1 4 0
1 6 0
Ti m e ( m on t h s )
BM
B
plasma
asm cell %
7(0-
7( 9
0- 0
9 )
0
10 (0-
0 90)
-
*,#
7 (0-52)
*,
7 (0-52)
O v er al l S u r v i val F r o m T r an sp l a n t
· 340 patients with myeloma who received their SCT within 12 months of diagnosis (median 5.8, range 3-12) were studied.
LDH
183
18
190
172
17
NS
Cr
C ea
e tin
a i
tin n
i e
1 (0
( .6-6.5
6 )
1 (0.7
0 -
.7 7
- .4
. )
4
1 (0.7
0 -
.7 3
- .9
. )
9
NS
1. 0
VA D
· Patients receiving more than one induction therapy as well as those patients in whom thalidomide was added to dexamethasone for
De x
T h al - D ex
(%)
(%
(%)
P
lack of response or progression were excluded from the analysis.
valu
l e
0. 8
Ge
G nde
e
r
nde :
r ma
m l
a e
56
64.3
54.7
NS
· There were 105 pts in the VAD group, 140 in the Dex group and 95 in the Thal-Dex group.
0. 6
al
Du
D rie Sa
S l
a mon
m
stage:
e
NS
ivrv
Su
2
27.
27 6
.
35.7
33.3
NS
· Responses were defined using standard criteria.
0. 4
3
72.
72 4
.
60
66.7
· Continuous variables were compared between the three groups using ANOVA and survival compared by Kaplan Meier analysis.
PC
P LI
L >=1%
15.
15 5
.
22.9
18.1
NS
0. 2
mi
m croglobulin
i >
21
25.2
21.3
NS
2
0. 0
3.5
0
2 0
4 0
6 0
8 0
1 00
120
1 40
160
Results and Conclusion
Ti m e ( m o n t h s )
Bone
B
di
d se
i a
se s
a e
s
12.
12 8
.
15.4
NS
O ver al l S u r v i v al F r o m D i ag n o si s
M Protei
e n: heavy
NS
chain[1]
in
· Baseline features at transplant are as in Table 1
1. 0
VA D
De x
IgG
Ig
60
58.6
55.7
NS
T hal - D ex
IgA
Ig
21
22
22
· The proportion of patients with any response to induction therapy was lower in the Dex group (65.7%) compared to VAD (74.3%)
0. 8
Light
h ch
c ai
a n:
NS
and Thal-Dex (83.2%).
0. 6
kappa
63.
63 8
.
66.2
61
NS
alivrv
· All pts in the Dex and the Thal-Dex groups received melphalan only conditioning compared to 70% in the VAD group, the rest
Su
Ab
A norma
m l
a
16.
16 2
.
20.7
16.3
NS
0. 4
cy
c to
y ge
g n
e etic
e s
tic
receiving Melphalan/TBI.
Circu
c l
u at
a itng
n PC at
31.
31 4
.
48.2
*,#
33.3
*,
33.3
0. 2
co
c lle
o c
lle tio
c n
tio
· An objective response was achieved after SCT in 96%, 97%, and 98% of pts in the VAD, Dex and Thal-Dex groups respectively
* VAD vs
v . Dex
De
(P=0.8).
0. 0
# De
D x
e vs.
vs Th
T a
h l
a Dex
e
0
2 0
4 0
6 0
8 0
100
120
140
160
**
* VAD
VA vs Th
T al
h Dex
Ti m e ( m o n t h s )
· A complete response to SCT was seen in 49% of patients in VAD group, 45% among those in the Dex group and 38% among those
in the Thal Dex group (P=0.38).
·Within the limits of this retrospective study, there does not appear to be any long term impact
· There was no difference in the median progression free survival after transplant (P=0.21) or overall survival from diagnosis (P=.34)
of the initial therapy for the patients going onto an early stem cell transplant and in these
between the three groups.
patients the choice of initial therapy should be based on other factors.
· The proportion free from progression at 2 years post transplant was 54%, 55% and 46% for Dex, VAD and Thal-Dex respectively.
·The results from initial therapy cannot be compared between the three regimens since the study
· The proportion surviving at 4 years from diagnosis was 64%, 65.4% and 72% respectively for the three groups.
population is restricted to patients reaching stem cell transplant.
Disclosures: No relevant conflicts of interest to disclose

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