Blood Journal
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CME article
Stem cell transplantation in multiple myeloma: impact of response failure with thalidomide or lenalidomide induction

  1. Morie A. Gertz1,
  2. Shaji Kumar1,
  3. Martha Q. Lacy1,
  4. Angela Dispenzieri1,
  5. David Dingli1,
  6. Suzanne R. Hayman1,
  7. Francis K. Buadi1, and
  8. William J. Hogan1
  1. 1Division of Hematology, Mayo Clinic, Rochester, MN

Abstract

Autologous stem cell transplantation as a platform for multiple myeloma treatment is the standard of care for patients who can safely withstand the procedure. Before novel agents were introduced, one-third to one-half of patients did not achieve partial response at transplantation. Previous medical literature has shown that in this past era, absence of initial response to induction therapy had no impact on progression-free survival and overall survival after high-dose therapy. Lack of response to initial induction did not preclude a good response after stem cell transplantation. With the introduction of novel agents—immunomodulatory drugs and proteasome inhibitors—response rates with initial therapy are now between 70% and 100%. This retrospective study analyzes progression-free survival and overall survival in patients who do not have a partial response (never responded or progressed during continuous therapy) after induction therapy with a regimen that contains thalidomide or lenalidomide. Unlike patients in reports published previously—before immunomodulatory drugs—patients who do not achieve partial remission have a significantly shorter overall survival from transplantation (73.5 vs 30.4 months) and a shorter progression-free survival (22.1 vs 13.1 months; P < .001). Absence of a response to induction therapy with thalidomide or lenalidomide predicts a poorer outcome after high-dose therapy.

Abstract

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This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of Medscape, LLC and the American Society of Hematology. Medscape, LLC is accredited by the ACCME to provide continuing medical education for physicians. Medscape, LLC designates this educational activity for a maximum of 0.5 AMA PRA Category 1 credits™. Physicians should only claim credit commensurate with the extent of their participation in the activity. All other clinicians completing this activity will be issued a certificate of participation. To participate in this journal CME activity: (1) review the learning objectives and author disclosures; (2) study the education content; (3) take the post-test and/or complete the evaluation at http://cme.medscape.com/journal/blood; and (4) view/print certificate. For CME questions, see page 2560.

Disclosures

Disclosures Morie A. Gertz is a member of the Millennium Advisory Board, received research support from Genzyme, and received honoraria from Millennium, Easi, Celgene, and Amgen. Shaji Kumar is a member of the Genzyme Advisory Board and has received research support from Celgene, Millennium, Novartis, Bayer, and Genzyme. Martha Q. Lacy participated in clinical trials funded by Celgene, Millennium, and Genzyme. The remaining authors; Editor Cynthia E. Dunbar; and CME questions author Charles P. Vega, University of California, Irvine, CA, declare no competing financial interests.

Learning objectives

Learning objectives Upon completion of this activity, participants will be able to:

  • Describe best current options for treatment of multiple myeloma

  • List the factors that are associated with better results on induction therapy

  • Compare cancer-specific and survival outcomes between patients with and without a good response to induction therapy for multiple myeloma

  • Submitted July 28, 2009.
  • Accepted December 26, 2009.
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