Recent trends in the management of newly diagnosed multiple myeloma

Current Opinion in Hematology

Volumn 16, Issue 4, 2009, Pages 306-312

  Reece, Donna E ^a  

^a PRINCESS MARGARET HOSPITAL   (Canada)

Author keywords

Allogeneic transplantation; Autologous transplantation; Multiple myeloma; Novel agents

Indexed keywords

ALPHA INTERFERON; BORTEZOMIB; BUSULFAN; CARMUSTINE; CYCLOPHOSPHAMIDE; DEXAMETHASONE; DOXORUBICIN; ETOPOSIDE; FLUDARABINE; IMMUNOMODULATING AGENT; LENALIDOMIDE; MELPHALAN; PLACEBO; PREDNISONE; THALIDOMIDE; THYMOCYTE ANTIBODY; VINCRISTINE;

ADD ON THERAPY; ALLOGENEIC STEM CELL TRANSPLANTATION; ALLOTRANSPLANTATION; AUTOLOGOUS STEM CELL TRANSPLANTATION; CLINICAL TRIAL; CYTOGENETICS; DRUG SAFETY; EVALUATION; FLUORESCENCE IN SITU HYBRIDIZATION; GROUPS BY AGE; HUMAN; IMMUNOMODULATION; INFORMATION; LOW DRUG DOSE; MAINTENANCE THERAPY; MEDICAL DECISION MAKING; MULTIPLE CYCLE TREATMENT; MULTIPLE MYELOMA; PRIORITY JOURNAL; PROGNOSIS; REVIEW; UNSPECIFIED SIDE EFFECT; WHOLE BODY RADIATION;

AGE FACTORS; AGED; ANTINEOPLASTIC COMBINED CHEMOTHERAPY PROTOCOLS; HUMANS; MIDDLE AGED; MULTIPLE MYELOMA; RANDOMIZED CONTROLLED TRIALS AS TOPIC; STEM CELL TRANSPLANTATION; SURVIVAL ANALYSIS; TRANSPLANTATION, AUTOLOGOUS;

EID: 67749116242     PISSN: 10656251     EISSN: 15317048     Source Type: Journal    
DOI: 10.1097/MOH.0b013e32832e3154     Document Type: Review

References (49)

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46. Schilling G, Hansen T, Shimoni A, et al. Impact of genetic abnormalities on survival after allogeneic hematopoietic stem cell transplantation in multiple myeloma. Leukemia 2008; 22:1250-1255. The authors assessed the most common FISH cytogenetic abnormalities in 101 patients undergoing nonmyeloablative alloSCT and observed that patients with del(17p) had lower complete remission and higher relapse rates. Older age and del(17p) were negative prognostic factors for EFS in multivariate analysis; patients with t(4;14) did not have lower response or EFS rates, however.
47. Bruno B, Rotta M, Patriara F, et al. A comparison of allografting with autografting for newly diagnosed myeloma. N Engl J Med 2007; 107:1110-1120.
48. Moreau P, Garban F, Attal M, et al. Long-term follow-up results of IFM99-03 and IMF99-04 trials comparing nonmyeloablative allotransplantation with autologous transplantation in high-risk de novo multiple myeloma. Blood 2008; 112:3914-3915. The parallel IFM trials in patients with both a high beta 2-microglobulin level and del(13q) have been updated and confirm the lack of any advantage for allografting; in fact, there was a trend for superior overall survival in favor of tandem ASCT (P=0.08). One explanation is that the antithymocyte globulin used as part of conditioning may have diminished a potentially beneficial graft-versus-myeloma effect.
49. Rosinol L, Perez-Simon JA, Sureda A, et al. A prospective study of tandem autologous transplantation versus autograft followed by reduced-intensity conditioning allogeneic transplantation in newly diagnosed multiple myeloma. Blood 2008; 112:3591-3593. In this study from the Spanish cooperative group, a significant number of eligible patients did not proceed to a second transplant due to patient or physician preference. Among the 110 who underwent either a second ASCT or a nonmyeloablative alloSCT, there were more complete remissions and a trend for longer PFS in the allograft arm, which was offset by a higher transplant-related mortality rate. There was no statistical difference in EFS or overall survival, although there appeared to be plateau in the PFS curve for allograft recipients.