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- W2116418771 abstract "High-dose chemotherapy and autologous stem cell transplantation (ASCT) in newly diagnosed multiple myeloma is the standard of care for eligible patients. Prior to ASCT, induction therapy is administered for 1 to 4 months before stem cell collection. Eligible patients undergo ASCT regardless of the response to induction therapy because it has been shown that a good response is not essential in order to obtain survival benefit from ASCT. A recent study that evaluated the novel agents, thalidomide and lenalidomide demonstrated that failure to achieve a partial response after induction therapy predicts a poorer outcome after ASCT. Fifty patients (60% male; median age 59 years) with multiple myeloma who underwent high-dose chemotherapy and ASCT after induction therapy with thalidomide, lenalidomide or bortezomib were retrospectively studied. The patients were divided into two groups according to their response after induction therapy: those with CR or VGPR; and those with PR or less than PR. Statistical analyses were performed. The median follow up was 33.4 (2.9-71.2) months. The M-protein at diagnosis was 3.4 ± 1.7 g/dl and the stage (Durie-Salmon) of the multiple myeloma was IIIa in 33 (66%) and IIIb in 9 (18%) patients. Beta-2 microglobulin was 4.9 ± 4.7 g/ml and 40% of patients had unfavorable cytogenetics defined as 13q- by cytogenetics, t(4,14), t(14,16), 17p- and complex karyotype. Favorable cytogenetics included normal, t(11,14) or 13q- by FISH. The induction therapy was thalidomide in 23 (46%), lenalidomide in 9 (18%), bortezomib in 8 (16%) and a combination in 10 (20%). The patients who achieved CR or VGPR after induction therapy were 23 (46%). These responses were associated with longer time to progression (HR = 0.42; p = 0.055) after ASTC. The progression-free survival (PFS) estimates for CR or VGPR vs PR or < PR were 48.6 months and 21.5 months respectively (p = 0.013). The presence of favorable cytogenetics was associated with a longer time to progression (HR = 0.345; p = 0.0174). A higher beta-2 microglobulin was associated with earlier time to progression (HR = 1.073; p = 0.0272). Achieving CR or VGPR with the novel agents prior to ASCT predicts a better PFS after transplantation. This suggests that extending induction therapy to achieve CR or VGPR prior to ASCT might be beneficial. Larger studies are needed to confim this finding." @default.
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- W2116418771 date "2011-02-01" @default.
- W2116418771 modified "2023-09-24" @default.
- W2116418771 title "Autologous Stem Cell Transplantation in Multiple Myeloma in the Era of Novel Agents: Impact of Depth of Response to Induction Therapy. A Single Institution Experience" @default.
- W2116418771 doi "https://doi.org/10.1016/j.bbmt.2010.12.156" @default.
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