Autologous transplant vs oral chemotherapy and lenalidomide in newly diagnosed young myeloma patients: A pooled analysis

Francesca Gay, S. Oliva, Maria Teresa Petrucci, V. Montefusco, C. Conticello, Pellegrino Musto, L Catalano, Andrea Evangelista, S. Spada, P. Campbell, R. Ria, M. Salvini, Massimo Offidani, Angelo-Michele Carella, P. Omedé, Anna M. Liberati, R. Troia, A. M. Cafro, A. Malfitano, A. P. Falcone & 7 others T. Caravita, F. Patriarca, A Nagler, A. Spencer, Alan R Hajek, Antonio Palumbo, Mario Boccadoro

Research output: Research - peer-reviewArticle

Abstract

In newly diagnosed myeloma patients, upfront autologous transplant (ASCT) prolongs progression-free survival 1 (PFS1) compared with chemotherapy plus lenalidomide (CC+R). Salvage ASCT at first relapse may still effectively rescue patients who did not receive upfront ASCT. To evaluate the long-term benefit of upfront ASCT vs CC+R and the impact of salvage ASCT in patients who received upfront CC+R, we conducted a pooled analysis of 2 phase III trials (RV-MM-209 and EMN-441). Primary endpoints were PFS1, progression-free survival 2 (PFS2), overall survival (OS). A total of 268 patients were randomized to 2 courses of melphalan 200 mg/m 2 and ASCT (MEL200-ASCT) and 261 to CC+R. Median follow-up was 46 months. MEL200-ASCT significantly improved PFS1 (median: 42 vs 24 months, HR 0.53; P<0.001), PFS2 (4 years: 71 vs 54%, HR 0.53, P<0.001) and OS (4 years: 84 vs 70%, HR 0.51, P<0.001) compared with CC+R. The advantage was noticed in good and bad prognosis patients. Only 53% of patients relapsing from CC+R received ASCT at first relapse. Upfront ASCT significantly reduced the risk of death (HR 0.51; P=0.007) in comparison with salvage ASCT. In conclusion, these data confirm the role of upfront ASCT as the standard approach for all young myeloma patients.

LanguageEnglish
Pages1727-1734
Number of pages8
JournalLeukemia
Volume31
Issue number8
DOIs
StatePublished - 1 Aug 2017
Externally publishedYes

Cite this

Gay, F., Oliva, S., Petrucci, M. T., Montefusco, V., Conticello, C., Musto, P., ... Boccadoro, M. (2017). Autologous transplant vs oral chemotherapy and lenalidomide in newly diagnosed young myeloma patients: A pooled analysis. Leukemia, 31(8), 1727-1734. DOI: 10.1038/leu.2016.381
Gay, Francesca ; Oliva, S. ; Petrucci, Maria Teresa ; Montefusco, V. ; Conticello, C. ; Musto, Pellegrino ; Catalano, L ; Evangelista, Andrea ; Spada, S. ; Campbell, P. ; Ria, R. ; Salvini, M. ; Offidani, Massimo ; Carella, Angelo-Michele ; Omedé, P. ; Liberati, Anna M. ; Troia, R. ; Cafro, A. M. ; Malfitano, A. ; Falcone, A. P. ; Caravita, T. ; Patriarca, F. ; Nagler, A ; Spencer, A. ; Hajek, Alan R ; Palumbo, Antonio ; Boccadoro, Mario. / Autologous transplant vs oral chemotherapy and lenalidomide in newly diagnosed young myeloma patients : A pooled analysis. In: Leukemia. 2017 ; Vol. 31, No. 8. pp. 1727-1734
@article{76cdbe905f754e28b3fc41fdd56b2d8c,
title = "Autologous transplant vs oral chemotherapy and lenalidomide in newly diagnosed young myeloma patients: A pooled analysis",
abstract = "In newly diagnosed myeloma patients, upfront autologous transplant (ASCT) prolongs progression-free survival 1 (PFS1) compared with chemotherapy plus lenalidomide (CC+R). Salvage ASCT at first relapse may still effectively rescue patients who did not receive upfront ASCT. To evaluate the long-term benefit of upfront ASCT vs CC+R and the impact of salvage ASCT in patients who received upfront CC+R, we conducted a pooled analysis of 2 phase III trials (RV-MM-209 and EMN-441). Primary endpoints were PFS1, progression-free survival 2 (PFS2), overall survival (OS). A total of 268 patients were randomized to 2 courses of melphalan 200 mg/m 2 and ASCT (MEL200-ASCT) and 261 to CC+R. Median follow-up was 46 months. MEL200-ASCT significantly improved PFS1 (median: 42 vs 24 months, HR 0.53; P<0.001), PFS2 (4 years: 71 vs 54%, HR 0.53, P<0.001) and OS (4 years: 84 vs 70%, HR 0.51, P<0.001) compared with CC+R. The advantage was noticed in good and bad prognosis patients. Only 53% of patients relapsing from CC+R received ASCT at first relapse. Upfront ASCT significantly reduced the risk of death (HR 0.51; P=0.007) in comparison with salvage ASCT. In conclusion, these data confirm the role of upfront ASCT as the standard approach for all young myeloma patients.",
author = "Francesca Gay and S. Oliva and Petrucci, {Maria Teresa} and V. Montefusco and C. Conticello and Pellegrino Musto and L Catalano and Andrea Evangelista and S. Spada and P. Campbell and R. Ria and M. Salvini and Massimo Offidani and Angelo-Michele Carella and P. Omedé and Liberati, {Anna M.} and R. Troia and Cafro, {A. M.} and A. Malfitano and Falcone, {A. P.} and T. Caravita and F. Patriarca and A Nagler and A. Spencer and Hajek, {Alan R} and Antonio Palumbo and Mario Boccadoro",
year = "2017",
month = "8",
doi = "10.1038/leu.2016.381",
volume = "31",
pages = "1727--1734",
journal = "Leukemia",
issn = "0887-6924",
publisher = "Macmillan Publishers",
number = "8",

}

Gay, F, Oliva, S, Petrucci, MT, Montefusco, V, Conticello, C, Musto, P, Catalano, L, Evangelista, A, Spada, S, Campbell, P, Ria, R, Salvini, M, Offidani, M, Carella, A-M, Omedé, P, Liberati, AM, Troia, R, Cafro, AM, Malfitano, A, Falcone, AP, Caravita, T, Patriarca, F, Nagler, A, Spencer, A, Hajek, AR, Palumbo, A & Boccadoro, M 2017, 'Autologous transplant vs oral chemotherapy and lenalidomide in newly diagnosed young myeloma patients: A pooled analysis' Leukemia, vol 31, no. 8, pp. 1727-1734. DOI: 10.1038/leu.2016.381

Autologous transplant vs oral chemotherapy and lenalidomide in newly diagnosed young myeloma patients : A pooled analysis. / Gay, Francesca; Oliva, S.; Petrucci, Maria Teresa; Montefusco, V.; Conticello, C.; Musto, Pellegrino; Catalano, L; Evangelista, Andrea; Spada, S.; Campbell, P.; Ria, R.; Salvini, M.; Offidani, Massimo; Carella, Angelo-Michele; Omedé, P.; Liberati, Anna M.; Troia, R.; Cafro, A. M.; Malfitano, A.; Falcone, A. P.; Caravita, T.; Patriarca, F.; Nagler, A; Spencer, A.; Hajek, Alan R; Palumbo, Antonio; Boccadoro, Mario.

In: Leukemia, Vol. 31, No. 8, 01.08.2017, p. 1727-1734.

Research output: Research - peer-reviewArticle

TY - JOUR

T1 - Autologous transplant vs oral chemotherapy and lenalidomide in newly diagnosed young myeloma patients

T2 - Leukemia

AU - Gay,Francesca

AU - Oliva,S.

AU - Petrucci,Maria Teresa

AU - Montefusco,V.

AU - Conticello,C.

AU - Musto,Pellegrino

AU - Catalano,L

AU - Evangelista,Andrea

AU - Spada,S.

AU - Campbell,P.

AU - Ria,R.

AU - Salvini,M.

AU - Offidani,Massimo

AU - Carella,Angelo-Michele

AU - Omedé,P.

AU - Liberati,Anna M.

AU - Troia,R.

AU - Cafro,A. M.

AU - Malfitano,A.

AU - Falcone,A. P.

AU - Caravita,T.

AU - Patriarca,F.

AU - Nagler,A

AU - Spencer,A.

AU - Hajek,Alan R

AU - Palumbo,Antonio

AU - Boccadoro,Mario

PY - 2017/8/1

Y1 - 2017/8/1

N2 - In newly diagnosed myeloma patients, upfront autologous transplant (ASCT) prolongs progression-free survival 1 (PFS1) compared with chemotherapy plus lenalidomide (CC+R). Salvage ASCT at first relapse may still effectively rescue patients who did not receive upfront ASCT. To evaluate the long-term benefit of upfront ASCT vs CC+R and the impact of salvage ASCT in patients who received upfront CC+R, we conducted a pooled analysis of 2 phase III trials (RV-MM-209 and EMN-441). Primary endpoints were PFS1, progression-free survival 2 (PFS2), overall survival (OS). A total of 268 patients were randomized to 2 courses of melphalan 200 mg/m 2 and ASCT (MEL200-ASCT) and 261 to CC+R. Median follow-up was 46 months. MEL200-ASCT significantly improved PFS1 (median: 42 vs 24 months, HR 0.53; P<0.001), PFS2 (4 years: 71 vs 54%, HR 0.53, P<0.001) and OS (4 years: 84 vs 70%, HR 0.51, P<0.001) compared with CC+R. The advantage was noticed in good and bad prognosis patients. Only 53% of patients relapsing from CC+R received ASCT at first relapse. Upfront ASCT significantly reduced the risk of death (HR 0.51; P=0.007) in comparison with salvage ASCT. In conclusion, these data confirm the role of upfront ASCT as the standard approach for all young myeloma patients.

AB - In newly diagnosed myeloma patients, upfront autologous transplant (ASCT) prolongs progression-free survival 1 (PFS1) compared with chemotherapy plus lenalidomide (CC+R). Salvage ASCT at first relapse may still effectively rescue patients who did not receive upfront ASCT. To evaluate the long-term benefit of upfront ASCT vs CC+R and the impact of salvage ASCT in patients who received upfront CC+R, we conducted a pooled analysis of 2 phase III trials (RV-MM-209 and EMN-441). Primary endpoints were PFS1, progression-free survival 2 (PFS2), overall survival (OS). A total of 268 patients were randomized to 2 courses of melphalan 200 mg/m 2 and ASCT (MEL200-ASCT) and 261 to CC+R. Median follow-up was 46 months. MEL200-ASCT significantly improved PFS1 (median: 42 vs 24 months, HR 0.53; P<0.001), PFS2 (4 years: 71 vs 54%, HR 0.53, P<0.001) and OS (4 years: 84 vs 70%, HR 0.51, P<0.001) compared with CC+R. The advantage was noticed in good and bad prognosis patients. Only 53% of patients relapsing from CC+R received ASCT at first relapse. Upfront ASCT significantly reduced the risk of death (HR 0.51; P=0.007) in comparison with salvage ASCT. In conclusion, these data confirm the role of upfront ASCT as the standard approach for all young myeloma patients.

UR - http://www.scopus.com/inward/record.url?scp=85010892441&partnerID=8YFLogxK

U2 - 10.1038/leu.2016.381

DO - 10.1038/leu.2016.381

M3 - Article

VL - 31

SP - 1727

EP - 1734

JO - Leukemia

JF - Leukemia

SN - 0887-6924

IS - 8

ER -

Gay F, Oliva S, Petrucci MT, Montefusco V, Conticello C, Musto P et al. Autologous transplant vs oral chemotherapy and lenalidomide in newly diagnosed young myeloma patients: A pooled analysis. Leukemia. 2017 Aug 1;31(8):1727-1734. Available from, DOI: 10.1038/leu.2016.381