Multiple myeloma: high-dose chemotherapy provides a viable bridge to transplant

  • Tabchi S & al.
  • Clin Lymphoma Myeloma Leuk
  • 17 May 2019

  • curated by David Reilly
  • Univadis Clinical Summaries
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Takeaway

  • High-dose cyclophosphamide, bortezomib, doxorubicin, and dexamethasone (mCBAD) may be an effective bridge to autologous stem cell transplantation (ASCT) in patients with relapsed/refractory (R/R) multiple myeloma (MM), limited therapeutic options, and good performance scores.

Why this matters

  • Multiple myeloma is characterized by refractoriness in advanced stages.

Study design

  • Review of outcomes in 140 patients with multiple myeloma and plasma cell leukemia receiving mCBAD.
  • 13 patients had newly diagnosed multiple myeloma (NDMM), 11 had plasma cell leukemia (PCL), and 116 had R/R MM.
  • Many patients had high-risk characteristics including kidney failure (70%), hypercalcemia (53%), anemia (100%), and bony lesions (80%).
  • Funding: MD Anderson Cancer Center support grant.

Key results

  • Overall response rate:
    • NDMM: 100%
    • PCL: 100%
    • R/R MM: 85%.
  • Complete response:
    • NDMM: 23.1%
    • PCL: 10%
    • R/R MM: 7.5%.
  • In patients with R/R MM:
    • 11.48 (95% CI, 7.52-15.9) months median PFS with subsequent ASCT vs 3.19 (95% CI, 2.4-3.75) months without.
    • 23 (95% CI, 17.1-36.1) months median OS with subsequent ASCT vs 9 (95% CI, 5.91-13.3) months without.
  • 7.8% treatment-related mortality (1 patient with PCL; 10 with R/R MM).

Limitations

  • Retrospective data.