Impact of Pretransplant Therapy and Depth of Disease Response before Autologous Transplantation for Multiple Myeloma

Ravi Vij; Shaji Kumar; Mei Jie Zhang; Xiaobo Zhong; Jiaxing Huang; Angela Dispenzieri; Muneer H. Abidi; Jennifer M. Bird; César O. Freytes; Robert Peter Gale; Tamila L. Kindwall-Keller; Robert A. Kyle; Daniel J. Landsburg; Hillard M. Lazarus; Reinhold Munker; Vivek Roy; Manish Sharma; Dan T. Vogl; Baldeep Wirk; Parameswaran N. Hari

doi:10.1016/j.bbmt.2014.10.023

Impact of Pretransplant Therapy and Depth of Disease Response before Autologous Transplantation for Multiple Myeloma

Ravi Vij, Shaji Kumar, Mei Jie Zhang, Xiaobo Zhong, Jiaxing Huang, Angela Dispenzieri, Muneer H. Abidi, Jennifer M. Bird, César O. Freytes, Robert Peter Gale, Tamila L. Kindwall-Keller, Robert A. Kyle, Daniel J. Landsburg, Hillard M. Lazarus, Reinhold Munker, Vivek Roy, Manish Sharma, Dan T. Vogl, Baldeep Wirk, Parameswaran N. Hari

Research output: Contribution to journal › Article › peer-review

65 Scopus citations

Abstract

Patients with multiple myeloma (MM) who are eligible for autologous stem cell transplantation (ASCT) typically receive a finite period of initial therapy before ASCT. It is not clear if patients with suboptimal (less than a partial) response to initial therapy benefit from additional alternative therapy with intent to maximize pretransplant response. We identified 539 patients with MM who had an ASCT after having achieved less than a partial response (PR) to first-line induction chemotherapy between 1995 and 2010. These patients were then divided into 2 groups: those who received additional salvage chemotherapy before ASCT (n=324) and those who had no additional salvage chemotherapy immediately before ASCT (n=215). Additional pretransplant chemotherapy resulted in deepening responses in 68% (complete response in 8% and PR in 60%). On multivariate analysis there was no impact of pretransplant salvage chemotherapy on treatment-related mortality, risk for relapse, progression-free survival, or overall survival. In conclusion, for patients achieving less than a PR to initial induction therapy, including with novel agent combinations, additional pre-ASCT salvage chemotherapy improved the depth of response and pre-ASCT disease status but was not associated with survival benefit.

Original language	English
Pages (from-to)	335-341
Number of pages	7
Journal	Biology of Blood and Marrow Transplantation
Volume	21
Issue number	2
DOIs	https://doi.org/10.1016/j.bbmt.2014.10.023
State	Published - Feb 1 2015

Bibliographical note

Publisher Copyright:
© 2015 American Society for Blood and Marrow Transplantation.

Funding

Financial disclosure: The CIBMTR is supported by Public Health Service Grant/Cooperative Agreement U24-CA076518 from the National Cancer Institute (NCI), the National Heart, Lung, and Blood Institute (NHLBI), and the National Institute of Allergy and Infectious Diseases (NIAID); Grant/Cooperative Agreement 5U10HL069294 from NHLBI and NCI ; contract HHSH250201200016C with the Health Resources and Services Administration; 2 grants ( N00014-12-1-0142 and N00014-13-1-0039 ) from the Office of Naval Research ; and grants from * Actinium Pharmaceuticals ; Allos Therapeutics, Inc. ; * Amgen, Inc. ; Anonymous donation to the Medical College of Wisconsin; Ariad ; Be The Match Foundation ; * Blue Cross and Blue Shield Association ; * Celgene Corporation ; Chimerix, Inc. ; Fred Hutchinson Cancer Research Center ; Fresenius-Biotech North America, Inc. ; * Gamida Cell Teva Joint Venture Ltd. ; Genentech, Inc. ; * Gentium SpA ; Genzyme Corporation ; GlaxoSmithKline ; Health Research, Inc. Roswell Park Cancer Institute ; HistoGenetics, Inc. ; Incyte Corporation ; Jeff Gordon Children's Foundation ; Kiadis Pharma ; The Leukemia & Lymphoma Society ; Medac GmbH ; The Medical College of Wisconsin; Merck & Co, Inc. ; Millennium: The Takeda Oncology Co .; * Milliman USA, Inc. ; * Miltenyi Biotec, Inc. ; National Marrow Donor Program ; Onyx Pharmaceuticals ; Optum Healthcare Solutions, Inc. ; Osiris Therapeutics, Inc. ; Otsuka America Pharmaceutical, Inc. ; Perkin Elmer, Inc. ; * Remedy Informatics ; * Sanofi US ; Seattle Genetics ; Sigma-Tau Pharmaceuticals ; Soligenix, Inc. ; St. Baldrick's Foundation ; StemCyte, A Global Cord Blood Therapeutics Co .; Stemsoft Software, Inc. ; Swedish Orphan Biovitrum ; * Tarix Pharmaceuticals ; * Terumo BCT ; * Teva Neuroscience, Inc. ; * Therakos ; University of Minnesota ; University of Utah ; and * WellPoint The views expressed in this article do not reflect the official policy or position of the National Institutes of Health, the Department of the Navy, the Department of Defense, Health Resources and Services Administration, or any other agency of the U.S. Government. Asterisk (*) indicates corporate members.

Funders	Funder number
Allos Therapeutics, Inc.
Office of Naval Research Naval Academy
National Heart, Lung, and Blood Institute (NHLBI)
National Childhood Cancer Registry – National Cancer Institute	U24CA076518
National Institute of Allergy and Infectious Diseases	HHSH250201200016C, 5U10HL069294
Health Resources and Services Administration	N00014-13-1-0039, N00014-12-1-0142
National Institute for Health Research Health Protection Research Unit
Actinium Pharmaceuticals Incorporated

Keywords

Autologous transplant
Myeloma
Primary refractory

ASJC Scopus subject areas

Hematology
Transplantation

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10.1016/j.bbmt.2014.10.023

Cite this

Vij, R., Kumar, S., Zhang, M. J., Zhong, X., Huang, J., Dispenzieri, A., Abidi, M. H., Bird, J. M., Freytes, C. O., Gale, R. P., Kindwall-Keller, T. L., Kyle, R. A., Landsburg, D. J., Lazarus, H. M., Munker, R., Roy, V., Sharma, M., Vogl, D. T., Wirk, B., & Hari, P. N. (2015). Impact of Pretransplant Therapy and Depth of Disease Response before Autologous Transplantation for Multiple Myeloma. Biology of Blood and Marrow Transplantation, 21(2), 335-341. https://doi.org/10.1016/j.bbmt.2014.10.023

@article{00971c61c0714de08409496c323cc22b,

title = "Impact of Pretransplant Therapy and Depth of Disease Response before Autologous Transplantation for Multiple Myeloma",

abstract = "Patients with multiple myeloma (MM) who are eligible for autologous stem cell transplantation (ASCT) typically receive a finite period of initial therapy before ASCT. It is not clear if patients with suboptimal (less than a partial) response to initial therapy benefit from additional alternative therapy with intent to maximize pretransplant response. We identified 539 patients with MM who had an ASCT after having achieved less than a partial response (PR) to first-line induction chemotherapy between 1995 and 2010. These patients were then divided into 2 groups: those who received additional salvage chemotherapy before ASCT (n=324) and those who had no additional salvage chemotherapy immediately before ASCT (n=215). Additional pretransplant chemotherapy resulted in deepening responses in 68\% (complete response in 8\% and PR in 60\%). On multivariate analysis there was no impact of pretransplant salvage chemotherapy on treatment-related mortality, risk for relapse, progression-free survival, or overall survival. In conclusion, for patients achieving less than a PR to initial induction therapy, including with novel agent combinations, additional pre-ASCT salvage chemotherapy improved the depth of response and pre-ASCT disease status but was not associated with survival benefit.",

keywords = "Autologous transplant, Myeloma, Primary refractory",

author = "Ravi Vij and Shaji Kumar and Zhang, \{Mei Jie\} and Xiaobo Zhong and Jiaxing Huang and Angela Dispenzieri and Abidi, \{Muneer H.\} and Bird, \{Jennifer M.\} and Freytes, \{C{\'e}sar O.\} and Gale, \{Robert Peter\} and Kindwall-Keller, \{Tamila L.\} and Kyle, \{Robert A.\} and Landsburg, \{Daniel J.\} and Lazarus, \{Hillard M.\} and Reinhold Munker and Vivek Roy and Manish Sharma and Vogl, \{Dan T.\} and Baldeep Wirk and Hari, \{Parameswaran N.\}",

note = "Publisher Copyright: {\textcopyright} 2015 American Society for Blood and Marrow Transplantation.",

year = "2015",

month = feb,

day = "1",

doi = "10.1016/j.bbmt.2014.10.023",

language = "English",

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Vij, R, Kumar, S, Zhang, MJ, Zhong, X, Huang, J, Dispenzieri, A, Abidi, MH, Bird, JM, Freytes, CO, Gale, RP, Kindwall-Keller, TL, Kyle, RA, Landsburg, DJ, Lazarus, HM, Munker, R, Roy, V, Sharma, M, Vogl, DT, Wirk, B & Hari, PN 2015, 'Impact of Pretransplant Therapy and Depth of Disease Response before Autologous Transplantation for Multiple Myeloma', Biology of Blood and Marrow Transplantation, vol. 21, no. 2, pp. 335-341. https://doi.org/10.1016/j.bbmt.2014.10.023

TY - JOUR

T1 - Impact of Pretransplant Therapy and Depth of Disease Response before Autologous Transplantation for Multiple Myeloma

AU - Vij, Ravi

AU - Kumar, Shaji

AU - Zhang, Mei Jie

AU - Zhong, Xiaobo

AU - Huang, Jiaxing

AU - Dispenzieri, Angela

AU - Abidi, Muneer H.

AU - Bird, Jennifer M.

AU - Freytes, César O.

AU - Gale, Robert Peter

AU - Kindwall-Keller, Tamila L.

AU - Kyle, Robert A.

AU - Landsburg, Daniel J.

AU - Lazarus, Hillard M.

AU - Munker, Reinhold

AU - Roy, Vivek

AU - Sharma, Manish

AU - Vogl, Dan T.

AU - Wirk, Baldeep

AU - Hari, Parameswaran N.

PY - 2015/2/1

Y1 - 2015/2/1

N2 - Patients with multiple myeloma (MM) who are eligible for autologous stem cell transplantation (ASCT) typically receive a finite period of initial therapy before ASCT. It is not clear if patients with suboptimal (less than a partial) response to initial therapy benefit from additional alternative therapy with intent to maximize pretransplant response. We identified 539 patients with MM who had an ASCT after having achieved less than a partial response (PR) to first-line induction chemotherapy between 1995 and 2010. These patients were then divided into 2 groups: those who received additional salvage chemotherapy before ASCT (n=324) and those who had no additional salvage chemotherapy immediately before ASCT (n=215). Additional pretransplant chemotherapy resulted in deepening responses in 68% (complete response in 8% and PR in 60%). On multivariate analysis there was no impact of pretransplant salvage chemotherapy on treatment-related mortality, risk for relapse, progression-free survival, or overall survival. In conclusion, for patients achieving less than a PR to initial induction therapy, including with novel agent combinations, additional pre-ASCT salvage chemotherapy improved the depth of response and pre-ASCT disease status but was not associated with survival benefit.

AB - Patients with multiple myeloma (MM) who are eligible for autologous stem cell transplantation (ASCT) typically receive a finite period of initial therapy before ASCT. It is not clear if patients with suboptimal (less than a partial) response to initial therapy benefit from additional alternative therapy with intent to maximize pretransplant response. We identified 539 patients with MM who had an ASCT after having achieved less than a partial response (PR) to first-line induction chemotherapy between 1995 and 2010. These patients were then divided into 2 groups: those who received additional salvage chemotherapy before ASCT (n=324) and those who had no additional salvage chemotherapy immediately before ASCT (n=215). Additional pretransplant chemotherapy resulted in deepening responses in 68% (complete response in 8% and PR in 60%). On multivariate analysis there was no impact of pretransplant salvage chemotherapy on treatment-related mortality, risk for relapse, progression-free survival, or overall survival. In conclusion, for patients achieving less than a PR to initial induction therapy, including with novel agent combinations, additional pre-ASCT salvage chemotherapy improved the depth of response and pre-ASCT disease status but was not associated with survival benefit.

KW - Autologous transplant

KW - Myeloma

KW - Primary refractory

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JO - Biology of Blood and Marrow Transplantation

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ER -

Impact of Pretransplant Therapy and Depth of Disease Response before Autologous Transplantation for Multiple Myeloma

Abstract

Bibliographical note

Funding

Keywords

ASJC Scopus subject areas

Access to Document

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