Efficacy of VDT PACE‐like regimens in treatment of relapsed/refractory multiple myeloma
Experience with intensive chemotherapy for relapsed/refractory multiple myeloma (RRMM) using VDT PACE regimen and its modifications (VDT PACE‐like regimens: VPLRs) outside TOTAL THERAPY trials is limited. We analyzed the outcomes of 141 patients with RRMM who received VPLRs at our center between 200...
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| Veröffentlicht in: | American journal of hematology 2018-02, Vol.93 (2), p.179-186 |
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| creator | Lakshman, Arjun Singh, Preet Paul Rajkumar, S. Vincent Dispenzieri, Angela Lacy, Martha Q. Gertz, Morie A. Buadi, Francis K. Dingli, David Hwa, Yi Lisa Fonder, Amie L. Hobbs, Miriam Hayman, Suzanne R. Zeldenrust, Steven R. Lust, John A. Russell, Stephen J. Leung, Nelson Kapoor, Prashant Go, Ronald S. Lin, Yi Gonsalves, Wilson I. Kourelis, Taxiarchis Warsame, Rahma Kyle, Robert A. Kumar, Shaji K. |
| description | Experience with intensive chemotherapy for relapsed/refractory multiple myeloma (RRMM) using VDT PACE regimen and its modifications (VDT PACE‐like regimens: VPLRs) outside TOTAL THERAPY trials is limited. We analyzed the outcomes of 141 patients with RRMM who received VPLRs at our center between 2006 and 2017 in an intent‐to‐treat analysis. Median age was 59.7 years and 66.7% of patients were male. A median of 2.2 years (range 0.02‐11.4) separated diagnosis of myeloma and inititation of VPLR. High‐risk cytogenetics were present in 52.4% patients. Patients received a median of 4 (range 1‐14) prior therapies, including stem cell transplant (SCT) in 66.7% patients. Ninety‐five (67.4%) patients received VDT PACE, 20 (14.2%) patients received VD PACE and 26 (18.4%) patients received other VPLRs. Patients received a median of 1 cycle (range 1‐9) of VPLR. We observed ≥ minimal response in 68.4%, ≥ partial response (PR) in 54.4% and ≥ very good PR in 10.3% patients. Median progression‐free survival was 3.1 months (95% CI, 1.9‐3.9) and median overall survival (OS) was 8.1 months (CI, 6.2‐9.9). One‐hundred and sixteen (82.3%) patients received some therapy after VPLR; 71 (61.2%) received systemic chemotherapy, while 45 (38.8%) underwent SCT. Median OS for those who received SCT after VPLR was 15.1 months (CI, 10.3‐20.8). Age ≥ 60 years (hazard ratio [HR] 2.3 [CI, 1.4‐3.7]; P = 0.0008) and R‐ISS III stage (HR‐ 2.4 [CI, 1.3‐4.0]; P = 0.003) predicted shorter OS in patients receiving VPLR. VPLRs are effective in heavily pre‐treated RRMM. In fit patients, SCT can be used to consolidate the response to VPLR. |
| doi_str_mv | 10.1002/ajh.24954 |
| format | Article |
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Vincent ; Dispenzieri, Angela ; Lacy, Martha Q. ; Gertz, Morie A. ; Buadi, Francis K. ; Dingli, David ; Hwa, Yi Lisa ; Fonder, Amie L. ; Hobbs, Miriam ; Hayman, Suzanne R. ; Zeldenrust, Steven R. ; Lust, John A. ; Russell, Stephen J. ; Leung, Nelson ; Kapoor, Prashant ; Go, Ronald S. ; Lin, Yi ; Gonsalves, Wilson I. ; Kourelis, Taxiarchis ; Warsame, Rahma ; Kyle, Robert A. ; Kumar, Shaji K.</creator><creatorcontrib>Lakshman, Arjun ; Singh, Preet Paul ; Rajkumar, S. Vincent ; Dispenzieri, Angela ; Lacy, Martha Q. ; Gertz, Morie A. ; Buadi, Francis K. ; Dingli, David ; Hwa, Yi Lisa ; Fonder, Amie L. ; Hobbs, Miriam ; Hayman, Suzanne R. ; Zeldenrust, Steven R. ; Lust, John A. ; Russell, Stephen J. ; Leung, Nelson ; Kapoor, Prashant ; Go, Ronald S. ; Lin, Yi ; Gonsalves, Wilson I. ; Kourelis, Taxiarchis ; Warsame, Rahma ; Kyle, Robert A. ; Kumar, Shaji K.</creatorcontrib><description>Experience with intensive chemotherapy for relapsed/refractory multiple myeloma (RRMM) using VDT PACE regimen and its modifications (VDT PACE‐like regimens: VPLRs) outside TOTAL THERAPY trials is limited. We analyzed the outcomes of 141 patients with RRMM who received VPLRs at our center between 2006 and 2017 in an intent‐to‐treat analysis. Median age was 59.7 years and 66.7% of patients were male. A median of 2.2 years (range 0.02‐11.4) separated diagnosis of myeloma and inititation of VPLR. High‐risk cytogenetics were present in 52.4% patients. Patients received a median of 4 (range 1‐14) prior therapies, including stem cell transplant (SCT) in 66.7% patients. Ninety‐five (67.4%) patients received VDT PACE, 20 (14.2%) patients received VD PACE and 26 (18.4%) patients received other VPLRs. Patients received a median of 1 cycle (range 1‐9) of VPLR. We observed ≥ minimal response in 68.4%, ≥ partial response (PR) in 54.4% and ≥ very good PR in 10.3% patients. Median progression‐free survival was 3.1 months (95% CI, 1.9‐3.9) and median overall survival (OS) was 8.1 months (CI, 6.2‐9.9). One‐hundred and sixteen (82.3%) patients received some therapy after VPLR; 71 (61.2%) received systemic chemotherapy, while 45 (38.8%) underwent SCT. Median OS for those who received SCT after VPLR was 15.1 months (CI, 10.3‐20.8). Age ≥ 60 years (hazard ratio [HR] 2.3 [CI, 1.4‐3.7]; P = 0.0008) and R‐ISS III stage (HR‐ 2.4 [CI, 1.3‐4.0]; P = 0.003) predicted shorter OS in patients receiving VPLR. VPLRs are effective in heavily pre‐treated RRMM. In fit patients, SCT can be used to consolidate the response to VPLR.</description><identifier>ISSN: 0361-8609</identifier><identifier>EISSN: 1096-8652</identifier><identifier>DOI: 10.1002/ajh.24954</identifier><identifier>PMID: 29067723</identifier><language>eng</language><publisher>United States: Wiley Subscription Services, Inc</publisher><subject>Aged ; Aged, 80 and over ; Antineoplastic Combined Chemotherapy Protocols - therapeutic use ; Chemotherapy ; Cisplatin - therapeutic use ; Clinical trials ; Cyclophosphamide - therapeutic use ; Cytogenetics ; Doxorubicin - therapeutic use ; Etoposide - therapeutic use ; Hematology ; Humans ; Middle Aged ; Multiple myeloma ; Multiple Myeloma - drug therapy ; Multiple Myeloma - mortality ; Multiple Myeloma - therapy ; Patients ; Salvage Therapy - methods ; Stem Cell Transplantation ; Survival Analysis ; Thalidomide ; Treatment Outcome ; Vincristine</subject><ispartof>American journal of hematology, 2018-02, Vol.93 (2), p.179-186</ispartof><rights>2017 Wiley Periodicals, Inc.</rights><rights>2018 Wiley Periodicals, Inc.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4804-3be120d5e74f57a8537a389096a742914700707395606f21300a8f03cd7f9eec3</citedby><cites>FETCH-LOGICAL-c4804-3be120d5e74f57a8537a389096a742914700707395606f21300a8f03cd7f9eec3</cites><orcidid>0000-0003-0240-0326 ; 0000-0001-8915-2382 ; 0000-0002-8284-3495 ; 0000-0002-5651-1411 ; 0000-0001-6890-969X</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1002%2Fajh.24954$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1002%2Fajh.24954$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,776,780,1411,1427,27901,27902,45550,45551,46384,46808</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/29067723$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Lakshman, Arjun</creatorcontrib><creatorcontrib>Singh, Preet Paul</creatorcontrib><creatorcontrib>Rajkumar, S. Vincent</creatorcontrib><creatorcontrib>Dispenzieri, Angela</creatorcontrib><creatorcontrib>Lacy, Martha Q.</creatorcontrib><creatorcontrib>Gertz, Morie A.</creatorcontrib><creatorcontrib>Buadi, Francis K.</creatorcontrib><creatorcontrib>Dingli, David</creatorcontrib><creatorcontrib>Hwa, Yi Lisa</creatorcontrib><creatorcontrib>Fonder, Amie L.</creatorcontrib><creatorcontrib>Hobbs, Miriam</creatorcontrib><creatorcontrib>Hayman, Suzanne R.</creatorcontrib><creatorcontrib>Zeldenrust, Steven R.</creatorcontrib><creatorcontrib>Lust, John A.</creatorcontrib><creatorcontrib>Russell, Stephen J.</creatorcontrib><creatorcontrib>Leung, Nelson</creatorcontrib><creatorcontrib>Kapoor, Prashant</creatorcontrib><creatorcontrib>Go, Ronald S.</creatorcontrib><creatorcontrib>Lin, Yi</creatorcontrib><creatorcontrib>Gonsalves, Wilson I.</creatorcontrib><creatorcontrib>Kourelis, Taxiarchis</creatorcontrib><creatorcontrib>Warsame, Rahma</creatorcontrib><creatorcontrib>Kyle, Robert A.</creatorcontrib><creatorcontrib>Kumar, Shaji K.</creatorcontrib><title>Efficacy of VDT PACE‐like regimens in treatment of relapsed/refractory multiple myeloma</title><title>American journal of hematology</title><addtitle>Am J Hematol</addtitle><description>Experience with intensive chemotherapy for relapsed/refractory multiple myeloma (RRMM) using VDT PACE regimen and its modifications (VDT PACE‐like regimens: VPLRs) outside TOTAL THERAPY trials is limited. We analyzed the outcomes of 141 patients with RRMM who received VPLRs at our center between 2006 and 2017 in an intent‐to‐treat analysis. Median age was 59.7 years and 66.7% of patients were male. A median of 2.2 years (range 0.02‐11.4) separated diagnosis of myeloma and inititation of VPLR. High‐risk cytogenetics were present in 52.4% patients. Patients received a median of 4 (range 1‐14) prior therapies, including stem cell transplant (SCT) in 66.7% patients. Ninety‐five (67.4%) patients received VDT PACE, 20 (14.2%) patients received VD PACE and 26 (18.4%) patients received other VPLRs. Patients received a median of 1 cycle (range 1‐9) of VPLR. We observed ≥ minimal response in 68.4%, ≥ partial response (PR) in 54.4% and ≥ very good PR in 10.3% patients. Median progression‐free survival was 3.1 months (95% CI, 1.9‐3.9) and median overall survival (OS) was 8.1 months (CI, 6.2‐9.9). One‐hundred and sixteen (82.3%) patients received some therapy after VPLR; 71 (61.2%) received systemic chemotherapy, while 45 (38.8%) underwent SCT. Median OS for those who received SCT after VPLR was 15.1 months (CI, 10.3‐20.8). Age ≥ 60 years (hazard ratio [HR] 2.3 [CI, 1.4‐3.7]; P = 0.0008) and R‐ISS III stage (HR‐ 2.4 [CI, 1.3‐4.0]; P = 0.003) predicted shorter OS in patients receiving VPLR. VPLRs are effective in heavily pre‐treated RRMM. In fit patients, SCT can be used to consolidate the response to VPLR.</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Antineoplastic Combined Chemotherapy Protocols - therapeutic use</subject><subject>Chemotherapy</subject><subject>Cisplatin - therapeutic use</subject><subject>Clinical trials</subject><subject>Cyclophosphamide - therapeutic use</subject><subject>Cytogenetics</subject><subject>Doxorubicin - therapeutic use</subject><subject>Etoposide - therapeutic use</subject><subject>Hematology</subject><subject>Humans</subject><subject>Middle Aged</subject><subject>Multiple myeloma</subject><subject>Multiple Myeloma - drug therapy</subject><subject>Multiple Myeloma - mortality</subject><subject>Multiple Myeloma - therapy</subject><subject>Patients</subject><subject>Salvage Therapy - methods</subject><subject>Stem Cell Transplantation</subject><subject>Survival Analysis</subject><subject>Thalidomide</subject><subject>Treatment Outcome</subject><subject>Vincristine</subject><issn>0361-8609</issn><issn>1096-8652</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kMFKAzEQhoMotlYPvoAseNFD20my2WyOpVarFPSggqclbie6NdutyS6yNx_BZ_RJjFY9CA4DMwMfP__8hOxTGFAANtSLxwGLlYg3SJeCSvppItgm6QJPaNhBdciO9wsASuMUtkmHKUikZLxL7ibGFLnO26gy0e3JdXQ1Gk_eX99s8YSRw4eixKWPimVUO9R1OOpP0KHVK4_zoUPjdF5Xro3KxtbFymJUtmirUu-SLaOtx73v2SM3p5Pr8bQ_uzw7H49m_Tx4ifv8HimDuUAZGyF1KrjUPFXhCy1jpmgsASRIrkQCiWGUA-jUAM_n0ijEnPfI0Vp35arnBn2dlYXP0Vq9xKrxGVVCJAxCB_TwD7qoGrcM7gKVCsFSHqpHjtdU7irvw4fZyhWldm1GIfvMOwt5Z195B_bgW7G5L3H-S_4EHIDhGngpLLb_K2Wji-la8gNdo4gA</recordid><startdate>201802</startdate><enddate>201802</enddate><creator>Lakshman, Arjun</creator><creator>Singh, Preet Paul</creator><creator>Rajkumar, S. 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Vincent ; Dispenzieri, Angela ; Lacy, Martha Q. ; Gertz, Morie A. ; Buadi, Francis K. ; Dingli, David ; Hwa, Yi Lisa ; Fonder, Amie L. ; Hobbs, Miriam ; Hayman, Suzanne R. ; Zeldenrust, Steven R. ; Lust, John A. ; Russell, Stephen J. ; Leung, Nelson ; Kapoor, Prashant ; Go, Ronald S. ; Lin, Yi ; Gonsalves, Wilson I. ; Kourelis, Taxiarchis ; Warsame, Rahma ; Kyle, Robert A. ; Kumar, Shaji K.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4804-3be120d5e74f57a8537a389096a742914700707395606f21300a8f03cd7f9eec3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Antineoplastic Combined Chemotherapy Protocols - therapeutic use</topic><topic>Chemotherapy</topic><topic>Cisplatin - therapeutic use</topic><topic>Clinical trials</topic><topic>Cyclophosphamide - therapeutic use</topic><topic>Cytogenetics</topic><topic>Doxorubicin - therapeutic use</topic><topic>Etoposide - therapeutic use</topic><topic>Hematology</topic><topic>Humans</topic><topic>Middle Aged</topic><topic>Multiple myeloma</topic><topic>Multiple Myeloma - drug therapy</topic><topic>Multiple Myeloma - mortality</topic><topic>Multiple Myeloma - therapy</topic><topic>Patients</topic><topic>Salvage Therapy - methods</topic><topic>Stem Cell Transplantation</topic><topic>Survival Analysis</topic><topic>Thalidomide</topic><topic>Treatment Outcome</topic><topic>Vincristine</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Lakshman, Arjun</creatorcontrib><creatorcontrib>Singh, Preet Paul</creatorcontrib><creatorcontrib>Rajkumar, S. 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Vincent</au><au>Dispenzieri, Angela</au><au>Lacy, Martha Q.</au><au>Gertz, Morie A.</au><au>Buadi, Francis K.</au><au>Dingli, David</au><au>Hwa, Yi Lisa</au><au>Fonder, Amie L.</au><au>Hobbs, Miriam</au><au>Hayman, Suzanne R.</au><au>Zeldenrust, Steven R.</au><au>Lust, John A.</au><au>Russell, Stephen J.</au><au>Leung, Nelson</au><au>Kapoor, Prashant</au><au>Go, Ronald S.</au><au>Lin, Yi</au><au>Gonsalves, Wilson I.</au><au>Kourelis, Taxiarchis</au><au>Warsame, Rahma</au><au>Kyle, Robert A.</au><au>Kumar, Shaji K.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Efficacy of VDT PACE‐like regimens in treatment of relapsed/refractory multiple myeloma</atitle><jtitle>American journal of hematology</jtitle><addtitle>Am J Hematol</addtitle><date>2018-02</date><risdate>2018</risdate><volume>93</volume><issue>2</issue><spage>179</spage><epage>186</epage><pages>179-186</pages><issn>0361-8609</issn><eissn>1096-8652</eissn><abstract>Experience with intensive chemotherapy for relapsed/refractory multiple myeloma (RRMM) using VDT PACE regimen and its modifications (VDT PACE‐like regimens: VPLRs) outside TOTAL THERAPY trials is limited. We analyzed the outcomes of 141 patients with RRMM who received VPLRs at our center between 2006 and 2017 in an intent‐to‐treat analysis. Median age was 59.7 years and 66.7% of patients were male. A median of 2.2 years (range 0.02‐11.4) separated diagnosis of myeloma and inititation of VPLR. High‐risk cytogenetics were present in 52.4% patients. Patients received a median of 4 (range 1‐14) prior therapies, including stem cell transplant (SCT) in 66.7% patients. Ninety‐five (67.4%) patients received VDT PACE, 20 (14.2%) patients received VD PACE and 26 (18.4%) patients received other VPLRs. Patients received a median of 1 cycle (range 1‐9) of VPLR. We observed ≥ minimal response in 68.4%, ≥ partial response (PR) in 54.4% and ≥ very good PR in 10.3% patients. Median progression‐free survival was 3.1 months (95% CI, 1.9‐3.9) and median overall survival (OS) was 8.1 months (CI, 6.2‐9.9). One‐hundred and sixteen (82.3%) patients received some therapy after VPLR; 71 (61.2%) received systemic chemotherapy, while 45 (38.8%) underwent SCT. Median OS for those who received SCT after VPLR was 15.1 months (CI, 10.3‐20.8). Age ≥ 60 years (hazard ratio [HR] 2.3 [CI, 1.4‐3.7]; P = 0.0008) and R‐ISS III stage (HR‐ 2.4 [CI, 1.3‐4.0]; P = 0.003) predicted shorter OS in patients receiving VPLR. VPLRs are effective in heavily pre‐treated RRMM. In fit patients, SCT can be used to consolidate the response to VPLR.</abstract><cop>United States</cop><pub>Wiley Subscription Services, Inc</pub><pmid>29067723</pmid><doi>10.1002/ajh.24954</doi><tpages>8</tpages><orcidid>https://orcid.org/0000-0003-0240-0326</orcidid><orcidid>https://orcid.org/0000-0001-8915-2382</orcidid><orcidid>https://orcid.org/0000-0002-8284-3495</orcidid><orcidid>https://orcid.org/0000-0002-5651-1411</orcidid><orcidid>https://orcid.org/0000-0001-6890-969X</orcidid><oa>free_for_read</oa></addata></record> |
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| source | Wiley Free Content; MEDLINE; Wiley Online Library Journals Frontfile Complete; EZB-FREE-00999 freely available EZB journals |
| subjects | Aged Aged, 80 and over Antineoplastic Combined Chemotherapy Protocols - therapeutic use Chemotherapy Cisplatin - therapeutic use Clinical trials Cyclophosphamide - therapeutic use Cytogenetics Doxorubicin - therapeutic use Etoposide - therapeutic use Hematology Humans Middle Aged Multiple myeloma Multiple Myeloma - drug therapy Multiple Myeloma - mortality Multiple Myeloma - therapy Patients Salvage Therapy - methods Stem Cell Transplantation Survival Analysis Thalidomide Treatment Outcome Vincristine |
| title | Efficacy of VDT PACE‐like regimens in treatment of relapsed/refractory multiple myeloma |
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