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Lenalidomide or bortezomib as maintenance treatment remedy the inferior impact of high-risk cytogenetic abnormalities in non-transplant patients with newly diagnosed multiple myeloma: a real-world multi-centered study in China

Maintenance treatment is a pivotal part in the whole process management of multiple myeloma (MM), which further deepens response and improves survival. However, evidence of maintenance in non-transplant MM patients is inadequate in real-world practice. Here, we retrospectively analyzed the efficacy...

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Autores principales: Zhuang, Zhe, Tian, Ying, Shi, Lei, Zou, Dongmei, Feng, Ru, Tian, Wei-wei, Yu, Hong, Dong, Fei, Liao, Aijun, Ma, Yanping, Liu, Qinhua, Liu, Shuangjiao, Jing, Hongmei, Fu, Rong, Ma, Liang-ming, Liu, Hui, Sun, Wanling, Bao, Li, Wu, Yin, Chen, Wenming, Zhuang, Junling
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10157094/
https://www.ncbi.nlm.nih.gov/pubmed/37152063
http://dx.doi.org/10.3389/fonc.2023.1028571
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author Zhuang, Zhe
Tian, Ying
Shi, Lei
Zou, Dongmei
Feng, Ru
Tian, Wei-wei
Yu, Hong
Dong, Fei
Liao, Aijun
Ma, Yanping
Liu, Qinhua
Liu, Shuangjiao
Jing, Hongmei
Fu, Rong
Ma, Liang-ming
Liu, Hui
Sun, Wanling
Bao, Li
Wu, Yin
Chen, Wenming
Zhuang, Junling
author_facet Zhuang, Zhe
Tian, Ying
Shi, Lei
Zou, Dongmei
Feng, Ru
Tian, Wei-wei
Yu, Hong
Dong, Fei
Liao, Aijun
Ma, Yanping
Liu, Qinhua
Liu, Shuangjiao
Jing, Hongmei
Fu, Rong
Ma, Liang-ming
Liu, Hui
Sun, Wanling
Bao, Li
Wu, Yin
Chen, Wenming
Zhuang, Junling
author_sort Zhuang, Zhe
collection PubMed
description Maintenance treatment is a pivotal part in the whole process management of multiple myeloma (MM), which further deepens response and improves survival. However, evidence of maintenance in non-transplant MM patients is inadequate in real-world practice. Here, we retrospectively analyzed the efficacy and survival of 375 non-transplant MM patients from 11 centers between 2010 and 2021 in north China. After a median of seven cycles of front-line regimens, there were 141, 79, and 155 patients receiving lenalidomide maintenance (L-MT), bortezomib maintenance (B-MT), or thalidomide maintenance (T-MT), respectively. Patients on L-MT and B-MT had significantly greater proportions of high-risk cytogenetic abnormalities (HRCAs) detected by fluorescence in situ hybridization (FISH), which was defined as 1q21 gain, 17p deletion, adverse immunoglobulin heavy chain (IgH) translocations. Although the progression-free survival (PFS) and overall survival (OS) were comparable among the three groups, L-MT and B-MT remedied the negative impact of HRCAs on survival (PFS of patients with HRCAs vs. patients without HRCAs: L-MT, 26.9 vs. 39.2 months, p=0.19; B-MT, 20.0 vs. 29.7 months, p=0.36; OS not reached in all groups). Patients with HRCAs in the T-MT group presented inferior clinical outcomes compared to standard-risk patients (PFS, 12.1 vs. 22.8 months, p=0.02, HR=1.8, 95% CI 1.0–3.4; OS, 54.9 months vs. NR, p<0.001, HR=3.2, 95% CI 1.5–7.0). Achieving complete response (CR) after induction therapy led to superior PFS compared to other degrees of response, regardless of maintenance medication. Furthermore, maintenance duration over 24 months correlated with favorable survival. Due to the large gap of transplant eligibility in China, optimizing maintenance therapy is important for non-transplant MM patients. In this real-world multi-centered study, our findings suggest that clinicians prefer to prescribe lenalidomide or bortezomib as maintenance therapy in high-risk settings, which are superior to thalidomide in non-transplant MM patients. Achievement of CR and maintenance duration over 2 years are positive factors that influence survival.
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spelling pubmed-101570942023-05-05 Lenalidomide or bortezomib as maintenance treatment remedy the inferior impact of high-risk cytogenetic abnormalities in non-transplant patients with newly diagnosed multiple myeloma: a real-world multi-centered study in China Zhuang, Zhe Tian, Ying Shi, Lei Zou, Dongmei Feng, Ru Tian, Wei-wei Yu, Hong Dong, Fei Liao, Aijun Ma, Yanping Liu, Qinhua Liu, Shuangjiao Jing, Hongmei Fu, Rong Ma, Liang-ming Liu, Hui Sun, Wanling Bao, Li Wu, Yin Chen, Wenming Zhuang, Junling Front Oncol Oncology Maintenance treatment is a pivotal part in the whole process management of multiple myeloma (MM), which further deepens response and improves survival. However, evidence of maintenance in non-transplant MM patients is inadequate in real-world practice. Here, we retrospectively analyzed the efficacy and survival of 375 non-transplant MM patients from 11 centers between 2010 and 2021 in north China. After a median of seven cycles of front-line regimens, there were 141, 79, and 155 patients receiving lenalidomide maintenance (L-MT), bortezomib maintenance (B-MT), or thalidomide maintenance (T-MT), respectively. Patients on L-MT and B-MT had significantly greater proportions of high-risk cytogenetic abnormalities (HRCAs) detected by fluorescence in situ hybridization (FISH), which was defined as 1q21 gain, 17p deletion, adverse immunoglobulin heavy chain (IgH) translocations. Although the progression-free survival (PFS) and overall survival (OS) were comparable among the three groups, L-MT and B-MT remedied the negative impact of HRCAs on survival (PFS of patients with HRCAs vs. patients without HRCAs: L-MT, 26.9 vs. 39.2 months, p=0.19; B-MT, 20.0 vs. 29.7 months, p=0.36; OS not reached in all groups). Patients with HRCAs in the T-MT group presented inferior clinical outcomes compared to standard-risk patients (PFS, 12.1 vs. 22.8 months, p=0.02, HR=1.8, 95% CI 1.0–3.4; OS, 54.9 months vs. NR, p<0.001, HR=3.2, 95% CI 1.5–7.0). Achieving complete response (CR) after induction therapy led to superior PFS compared to other degrees of response, regardless of maintenance medication. Furthermore, maintenance duration over 24 months correlated with favorable survival. Due to the large gap of transplant eligibility in China, optimizing maintenance therapy is important for non-transplant MM patients. In this real-world multi-centered study, our findings suggest that clinicians prefer to prescribe lenalidomide or bortezomib as maintenance therapy in high-risk settings, which are superior to thalidomide in non-transplant MM patients. Achievement of CR and maintenance duration over 2 years are positive factors that influence survival. Frontiers Media S.A. 2023-04-20 /pmc/articles/PMC10157094/ /pubmed/37152063 http://dx.doi.org/10.3389/fonc.2023.1028571 Text en Copyright © 2023 Zhuang, Tian, Shi, Zou, Feng, Tian, Yu, Dong, Liao, Ma, Liu, Liu, Jing, Fu, Ma, Liu, Sun, Bao, Wu, Chen and Zhuang https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Oncology
Zhuang, Zhe
Tian, Ying
Shi, Lei
Zou, Dongmei
Feng, Ru
Tian, Wei-wei
Yu, Hong
Dong, Fei
Liao, Aijun
Ma, Yanping
Liu, Qinhua
Liu, Shuangjiao
Jing, Hongmei
Fu, Rong
Ma, Liang-ming
Liu, Hui
Sun, Wanling
Bao, Li
Wu, Yin
Chen, Wenming
Zhuang, Junling
Lenalidomide or bortezomib as maintenance treatment remedy the inferior impact of high-risk cytogenetic abnormalities in non-transplant patients with newly diagnosed multiple myeloma: a real-world multi-centered study in China
title Lenalidomide or bortezomib as maintenance treatment remedy the inferior impact of high-risk cytogenetic abnormalities in non-transplant patients with newly diagnosed multiple myeloma: a real-world multi-centered study in China
title_full Lenalidomide or bortezomib as maintenance treatment remedy the inferior impact of high-risk cytogenetic abnormalities in non-transplant patients with newly diagnosed multiple myeloma: a real-world multi-centered study in China
title_fullStr Lenalidomide or bortezomib as maintenance treatment remedy the inferior impact of high-risk cytogenetic abnormalities in non-transplant patients with newly diagnosed multiple myeloma: a real-world multi-centered study in China
title_full_unstemmed Lenalidomide or bortezomib as maintenance treatment remedy the inferior impact of high-risk cytogenetic abnormalities in non-transplant patients with newly diagnosed multiple myeloma: a real-world multi-centered study in China
title_short Lenalidomide or bortezomib as maintenance treatment remedy the inferior impact of high-risk cytogenetic abnormalities in non-transplant patients with newly diagnosed multiple myeloma: a real-world multi-centered study in China
title_sort lenalidomide or bortezomib as maintenance treatment remedy the inferior impact of high-risk cytogenetic abnormalities in non-transplant patients with newly diagnosed multiple myeloma: a real-world multi-centered study in china
topic Oncology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10157094/
https://www.ncbi.nlm.nih.gov/pubmed/37152063
http://dx.doi.org/10.3389/fonc.2023.1028571
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