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Jeannine
01-08-2010, 09:49 PM
Results of Autologous Stem Cell Transplantation for Older Patients with Myeloma Improved by Adding Velcade? and Revlimid?

Researchers from Italy have reported excellent results of adding Velcade? (bortezomib) and Revlimid? (lenalidomide) to a reduced-intensity tandem autologous stem cell transplant regimen for older patients with myeloma . The details of this study appeared in an early online publication in the Journal of Clinical Oncology on January 4, 2010.[1]

Over the past two decades, there has been marked improvement in overall survival of patients with multiple myeloma. This improvement in survival has been due to the adoption of single or tandem melphalan-based autologous stem cell transplants in younger, fitter patients as well as the development of new drugs such as Thalomid? (thalidomide), Revlimid, and Velcade. These new drugs have improved outcomes of patients not suitable for stem cell transplantation and are now beginning to have an impact of transplant patients as well.

The current study involved 102 newly diagnosed patients with multiple myeloma who were 65 to 75 years of age. Induction therapy was a combination of Velcade, Doxil? (liposomal doxorubicin), and dexamethasone. All patients were scheduled to receive tandem reduced-intensity autologous stem cell transplants. The dose of melphalan was reduced from the standard 200 mg/m2 to 100 mg/m2. Peripheral blood stem cells were harvested after Cytoxan? (cyclophosphamide) and Neupogen? (figrastim). Four cycles of Revlimid were given for consolidation followed by Revlimid maintenance.

After induction therapy, 58% had a very good partial response (VGPR) or better with a 13% complete response (CR) rate.
After transplantation, 82% had a VGPR or better with a CR rate of 38%.
After Revlimid maintenance, 86% had a VGPR or with a CR rate of 66%.
Two-year progression-free survival was 69%.
Two-year overall survival was 86%.
Comments: This is a very interesting study showing that tandem autologous transplants can be administered to myeloma patients between the ages of 65 and 75 years. The addition of Revlimid and Velcade appears to also benefit outcomes in this group of patients with myeloma.

Reference:

[1] Palumbo A, Gay F, Falco P, et al. Bortezomib as induction before autologous transplantation, followed by lenalidomide as consolidation-maintenance in untreated multiple myeloma. Journal of Clinical Oncology [early online publication]. January 4, 2010.



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