Prognostic impact of early-versus-late responses to different induction regimens in patients with myeloma undergoing autologous hematopoietic cell transplantation: Results from the CALM study by the CMWP of the EBMT

Laurent Garderet, Giulia Sbianchi, Simona Iacobelli, Didier Blaise, Jenny L. Byrne, Peter Remenyi, Jane F. Apperley, Cyrille Touzeau, Cecilia Isaksson, Paul Browne, Jiri Mayer, Stig Lenhoff, Soledad Gonzalez Muniz, Rocio Parody Porras, Grzegorz Basak, Xavier Poire, Marek Trneny, Arnon Nagler, Mariagrazia Michieli, Alina TanaseLinda Koster, Patrick J. Hayden, Meral Beksac, Stefan Schönland, Ibrahim Yakoub-Agha

Research output: Contribution to journalArticlepeer-review

Abstract

Background: In autologous stem cell transplant (ASCT)-eligible myeloma patients, prolonged induction does not necessarily improve the depth of response. Method: We analyzed 1222 ASCT patients who were classified based on (a) the interval between induction and stem cell collection, (b) the type of induction regimen: BID (Bortezomib, IMiDs, and Dexamethasone), Bortezomib-based, or CTD (Cyclophosphamide, Thalidomide, and Dexamethasone), and (c) the time to best response (Early ie, best response within 4 or 5 months, depending on the regimen vs Late; Good ie, VGPR or better vs Poor). Results: The length of induction treatment required to achieve a Good response did not affect PFS (P =.65) or OS (P =.61) post-ASCT. The three types of regimen resulted in similar outcomes: median PFS 31, 27.7 and 30.8 months (P =.31), and median OS 81.7, 92.7, and 77.4 months, respectively (P =.83). On multivariate analysis, neither the type nor the duration of the induction regimen affected OS and PFS, except for Early Good Responders who had a better PFS compared to Early Poor Responders (HR = 1.21, P-value =.02). However, achieving a Good response at induction was associated with a better response (≥VGPR) post-transplant. Conclusion: The kinetics of response did not affect outcomes.

Original languageEnglish
Pages (from-to)708-715
Number of pages8
JournalEuropean Journal of Haematology
Volume106
Issue number5
DOIs
StatePublished - May 2021
Externally publishedYes

Keywords

  • autologous transplantation
  • induction regimen
  • kinetics of response
  • multiple myeloma

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