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Early response-based intensification of primary therapy in newly diagnosed multiple myeloma patients who are eligible for autologous stem cell transplantation: phase II study

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Abstract

This phase II study prospectively evaluated the efficacy and tolerability of an early change in induction therapy before autologous stem cell transplantation (ASCT) in multiple myeloma (MM) patients who failed to achieve more than a partial response (PR) after two cycles of a cyclophosphamide, thalidomide, and dexamethasone (CTD) regimen. Patients aged 18–65 years received two cycles of CTD therapy, and then the patients who achieved more than a PR received two additional cycles of CTD therapy, while those who failed to achieve more than a PR were given intensified therapy with four cycles of a Vel-CD regimen (bortezomib, cyclophosphamide, and dexamethasone). After completing primary chemotherapy, the patients underwent ASCT. This study initially enrolled 64 patients, although four were excluded. Of the patients, 60 were treated with CTD regimen and 8 patients also had the intensified Vel-CD regimen, of whom five showing improved responses. The overall response rate before ASCT in 59 patients was 94.9 %, including 27.1 % with a stringent complete response/complete response, 23.7 % with a very good partial response (VGPR), and 44.1 % with a PR. The median time to progression (TTP) was 33.2 months (95 % CI, 26.6–34.8). Patients who attained a VGPR or better after ASCT tended to have a longer TTP than the patients who did not (not reached vs. 24.2 months, P = 0.04). In conclusion, early response-adapted intensification with a Vel-CD regimen was a well-tolerated, effective strategy for improving the response before ASCT in patients with newly diagnosed MM.

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The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Hematology-Oncology, Chonnam National University Hwasun Hospital, 322 Seoyangro, Hwasun, Jeollanamdo, 519-763, Republic of Korea

    Seo-Yeon Ahn, Sung-Hoon Jung & Je-Jung Lee

  2. Inje University Haeundae Paik Hospital, Busan, Republic of Korea

    Young Don Joo

  3. Inje University Busan Paik Hospital, Busan, Republic of Korea

    Won Sik Lee & Sang Min Lee

  4. Korea University Guro Hospital, Seoul, Republic of Korea

    Chul Won Choi

  5. Department of Medicine, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Republic of Korea

    Seok Jin Kim & Kihyun Kim

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  1. Seo-Yeon Ahn
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  2. Sung-Hoon Jung
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  3. Young Don Joo
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  4. Won Sik Lee
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  5. Sang Min Lee
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  7. Seok Jin Kim
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  8. Kihyun Kim
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  9. Je-Jung Lee
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Korean Multiple Myeloma Working Party

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Correspondence to Je-Jung Lee.

Additional information

Seo-Yeon Ahn and Sung-Hoon Jung contributed equally to this work.

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Ahn, SY., Jung, SH., Joo, Y.D. et al. Early response-based intensification of primary therapy in newly diagnosed multiple myeloma patients who are eligible for autologous stem cell transplantation: phase II study. Ann Hematol 93, 1571–1577 (2014). https://doi.org/10.1007/s00277-014-2067-3

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  • DOI: https://doi.org/10.1007/s00277-014-2067-3

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