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Improved survival in multiple myeloma patients following three-drug therapy with autologous stem cell transplant

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Patients with multiple myeloma who have been treated in combination with three medications have a wide range of options for future treatment. The results of a new study led by researchers at the Dana-Farber Cancer Center may help patients and physicians measure the benefits and risks of each option.

The study, presented today at the American Society of Asylum Seekers (ASCO) as a regular session and published simultaneously in New England Journal of Medicinefound that my newly diagnosed patients who were treated with triad drugs (abbreviated as RVd) lived longer without harming them if they received an automatic dose. dashi soon after RVd treatment than if only their cells had been collected for future transplantation. However, patients remained as likely to live more than six years after treatment regardless of whether they had an immediate transplant or chose to keep transplanting as the next option. Essential use of lenalidomide treatment in both groups continued until progression provided clinical benefit.

Some important factors influence the outcome. While autoimmune transfusions lead to premature death (PFS) – the length of time patients survive without recurrence of cancer – the number of doses of melphalan chemotherapy given before transplant increases the risk of infants. health. develops secondary leukemia and later myelodysplasia. Patients who have an early transplant are also more likely to have serious side effects than those who decide to continue the transplant, but these side effects usually subside three or four months after the transplant, giving patients a better quality of life. for a long time, however. significant reduction during transplantation.

In addition, the researchers found that patients with dementia (MRD) following RVd — meaning tests still found fewer rates. myeloma Cells in their body — they have a higher PFS if transplanted earlier than if they delayed transplantation. However, the patients who were diagnosed did not have MRD after first treatment it depends on whether they were transplanted early or not.

“Now more than ever, multiple myeloma treatment can be tailored to any patient,” she said Paul G. Richardson, MDClinical program leader and clinical research director in Jerome Lipper Multiple Myeloma Center at Dana-Farberwho will present the research findings at ASCO and is the lead author of the paper New England Journal of Medicine. “Our research provides important insights into the benefits of transplantation in the age of improved therapies and continued care, as well as risk factors, to help patients and clinicians decide the best course of action. they.

The randomized controlled trial, dubbed the DETERMINATION study, placed 722 patients under the age of 65 with multiple myeloma. Eighteen percent of the participants were African-American — whose risk of developing myeloma doubled was whiter — giving the highest registered African-American test of any type of myeloma treatment to date. Fifty-six cancer centers across the United States participated in the study. Dana-Farber’s Kenneth C. Anderson, MD, program director of the Jerome Lipper Multiple Myeloma Center and LeBow Institute for Myeloma Therapeutics, and Nikhil Munshi, MD, director of Basic and Correlative Science at the Jerome Lipper Multiple Myeloma Center, are key partners. the authors of the study.

All participants received RVd combination therapy, which included the drugs lenalidomide (Revlimid), bortezomib (Velcade), and dexamethasone. Afterwards, they all received lenalidomide as a “design” therapy to keep the myeloma from recurring until it progressed. Half were randomly assigned to undergo automatic cell transplantation (using their own cells) shortly after completing the initial treatment with RVd, and half received their own. add cells collected and stored for future transplantation.

As a group, participants received the best response to the RVd of any survey to date, Richardson said. Patients on each arm of the trial responded to treatment in almost the same total amount to respond with a complete response. Patients who were not transplanted early had an average PFS of 48 months; In contrast, those who received early transplant had an average PFS of 68 months — or more than five years. However, the total life expectancy is about the same — about 85% — for both groups with an average duration of 76 months.

“This tells us that for patients who have had a transplant, they have the same life expectancy as those who have had a transplant immediately, although the first stage of infection is available to patients who have been transplanted. early on, ”Richardson. statements. “Our data also show that care is important and useful as long as progress is the key to improving outcomes.”

He went on to say that when their disease recurred, patients who delayed the delivery received new therapies and procedures, such as. monoclonal antibodies and / or representatives of the next story and have had the same life as those who were born early. Indeed, the researchers found that only 28% of patients used the transplant option.

“It shows the extent to which patients have options now and that we have new data to guide them in adjusting their amenities and priorities for each course,” he said.

The study also provided evidence of one of the most important long-term risks associated with large amounts of melphalan and automatic cell transplantation. Ten of the patients who were transplanted early had advanced acute myocardial infarction (AML) or myelodysplastic syndrome (MDS) within six years after transplant, while no other patient on the other hand had a test. . Both secondary AML and MDS are difficult to treat cancer and are unlucky, but the risk of developing them increases over time – an important consideration for younger patients considering early transplants in method of treatment.

The patients in the study will continue to monitor the impact of overall life and long-term safety. List-genome in general to assess mutagenicity of treatment and its effects; further evaluation of quality of life, and other studies are underway.


DNA damage indicates a risk of recurrence after transplantation in DLBCL patients


Learn more:
Triple Treatment, Transplantation, and Care Up to Progress in Myeloma (Predestination), New England Journal of Medicine (2022).

hint: Improved quality of life in many myeloma patients following three treatment regimens with automatic transplantation (2022, June 5) Retrieved 5 June 2022 from https://medicalxpress.com/news/2022-06 -survival-multiple-myeloma-patients- three drugs.html

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