TY - JOUR
T1 - Autologous transplant vs oral chemotherapy and lenalidomide in newly diagnosed young myeloma patients
T2 - A pooled analysis
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
AN - SCOPUS:85010892441
SN - 0887-6924
VL - 31
SP - 1727
EP - 1734
JO - Leukemia
JF - Leukemia
IS - 8
ER -
