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VTD-melphalan is well tolerated and results in very high rates of stringent CR and MRD-negative status in multiple myeloma

The addition of cytotoxic drugs to high-dose melphalan as a preparative regimen for autologous stem cell transplantation in multiple myeloma has not resulted in superior activity. Although novel agents have significantly improved outcome in multiple myeloma, their role in preparative regimens remain...

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Autores principales: Nadiminti, Kalyan, Singh Abbi, Kamal Kant, Mott, Sarah L, Dozeman, Lindsay, Tricot, Annick, Schultz, Allyson, Behrends, Sonya, Zhan, Fenghuang, Tricot, Guido
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Dove Medical Press 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5229169/
https://www.ncbi.nlm.nih.gov/pubmed/28123303
http://dx.doi.org/10.2147/OTT.S112423
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author Nadiminti, Kalyan
Singh Abbi, Kamal Kant
Mott, Sarah L
Dozeman, Lindsay
Tricot, Annick
Schultz, Allyson
Behrends, Sonya
Zhan, Fenghuang
Tricot, Guido
author_facet Nadiminti, Kalyan
Singh Abbi, Kamal Kant
Mott, Sarah L
Dozeman, Lindsay
Tricot, Annick
Schultz, Allyson
Behrends, Sonya
Zhan, Fenghuang
Tricot, Guido
author_sort Nadiminti, Kalyan
collection PubMed
description The addition of cytotoxic drugs to high-dose melphalan as a preparative regimen for autologous stem cell transplantation in multiple myeloma has not resulted in superior activity. Although novel agents have significantly improved outcome in multiple myeloma, their role in preparative regimens remains largely unknown. We have evaluated the toxicity and efficacy of combining bortezomib, thalidomide, and dexamethasone with high-dose melphalan. An institutional review board-approved retrospective analysis was performed on 100 consecutive patients receiving 153 transplants; 53 had tandem transplants; 64 patients received early transplants; and 36 had salvage transplantation. Endpoints were treatment-related toxicity and mortality, and quality of response post-transplantation with assessment of stringent complete remission (sCR) and minimal residual disease (MRD) status. Median age was 61 years, and median follow-up was 16.2 months. At 6 months, sCR was attained in 56% of patients and CR in 20%. An MRD status, assessed by sensitive (10(−4)) multiparameter flow cytometry, was achieved in 85%. The 100-day mortality rate was 2.6% (4/153); 1.8% for early transplants and 4.5% for salvage transplants. Grade 3–5 non-hematologic toxicities were mainly related to metabolism/nutrition; gastrointestinal and infectious problems. Median time to absolute neutrophil count of >500/µL was 12 days for both early and salvage transplantations. No significant differences in quality of response were observed between early and salvage transplantation or between single and tandem autologous stem cell transplantation. Since both sCR and MRD are excellent early surrogate markers for progression-free and overall survival, this regimen will likely be superior to melphalan alone, but it needs to be formally assessed in a randomized study.
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spelling pubmed-52291692017-01-25 VTD-melphalan is well tolerated and results in very high rates of stringent CR and MRD-negative status in multiple myeloma Nadiminti, Kalyan Singh Abbi, Kamal Kant Mott, Sarah L Dozeman, Lindsay Tricot, Annick Schultz, Allyson Behrends, Sonya Zhan, Fenghuang Tricot, Guido Onco Targets Ther Original Research The addition of cytotoxic drugs to high-dose melphalan as a preparative regimen for autologous stem cell transplantation in multiple myeloma has not resulted in superior activity. Although novel agents have significantly improved outcome in multiple myeloma, their role in preparative regimens remains largely unknown. We have evaluated the toxicity and efficacy of combining bortezomib, thalidomide, and dexamethasone with high-dose melphalan. An institutional review board-approved retrospective analysis was performed on 100 consecutive patients receiving 153 transplants; 53 had tandem transplants; 64 patients received early transplants; and 36 had salvage transplantation. Endpoints were treatment-related toxicity and mortality, and quality of response post-transplantation with assessment of stringent complete remission (sCR) and minimal residual disease (MRD) status. Median age was 61 years, and median follow-up was 16.2 months. At 6 months, sCR was attained in 56% of patients and CR in 20%. An MRD status, assessed by sensitive (10(−4)) multiparameter flow cytometry, was achieved in 85%. The 100-day mortality rate was 2.6% (4/153); 1.8% for early transplants and 4.5% for salvage transplants. Grade 3–5 non-hematologic toxicities were mainly related to metabolism/nutrition; gastrointestinal and infectious problems. Median time to absolute neutrophil count of >500/µL was 12 days for both early and salvage transplantations. No significant differences in quality of response were observed between early and salvage transplantation or between single and tandem autologous stem cell transplantation. Since both sCR and MRD are excellent early surrogate markers for progression-free and overall survival, this regimen will likely be superior to melphalan alone, but it needs to be formally assessed in a randomized study. Dove Medical Press 2017-01-06 /pmc/articles/PMC5229169/ /pubmed/28123303 http://dx.doi.org/10.2147/OTT.S112423 Text en © 2017 Nadiminti et al. This work is published and licensed by Dove Medical Press Limited The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.
spellingShingle Original Research
Nadiminti, Kalyan
Singh Abbi, Kamal Kant
Mott, Sarah L
Dozeman, Lindsay
Tricot, Annick
Schultz, Allyson
Behrends, Sonya
Zhan, Fenghuang
Tricot, Guido
VTD-melphalan is well tolerated and results in very high rates of stringent CR and MRD-negative status in multiple myeloma
title VTD-melphalan is well tolerated and results in very high rates of stringent CR and MRD-negative status in multiple myeloma
title_full VTD-melphalan is well tolerated and results in very high rates of stringent CR and MRD-negative status in multiple myeloma
title_fullStr VTD-melphalan is well tolerated and results in very high rates of stringent CR and MRD-negative status in multiple myeloma
title_full_unstemmed VTD-melphalan is well tolerated and results in very high rates of stringent CR and MRD-negative status in multiple myeloma
title_short VTD-melphalan is well tolerated and results in very high rates of stringent CR and MRD-negative status in multiple myeloma
title_sort vtd-melphalan is well tolerated and results in very high rates of stringent cr and mrd-negative status in multiple myeloma
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5229169/
https://www.ncbi.nlm.nih.gov/pubmed/28123303
http://dx.doi.org/10.2147/OTT.S112423
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