IMWG consensus on maintenance therapy in multiple myeloma

被引：145

作者：

Ludwig, Heinz ^{[1
]}

Durie, Brian G. M. ^{[2
,3
]}

McCarthy, Philip ^{[4
]}

Palumbo, Antonio ^{[5
]}

San Miguel, Jesus ^{[6
]}

Barlogie, Bart ^{[7
]}

Morgan, Gareth ^{[9
]}

Sonneveld, Pieter ^{[8
]}

Spencer, Andrew ^{[10
]}

Andersen, Kenneth C. ^{[11
]}

Facon, Thierry ^{[12
]}

Stewart, Keith A. ^{[13
]}

Einsele, Hermann ^{[14
]}

Mateos, Maria-Victoria ^{[6
]}

Wijermans, Pierre ^{[15
]}

Waage, Anders ^{[16
]}

Beksac, Meral ^{[17
]}

Richardson, Paul G. ^{[11
]}

Hulin, Cyrille ^{[18
]}

Niesvizky, Ruben ^{[19
]}

Lokhorst, Henk ^{[20
]}

Landgren, Ola ^{[21
]}

Bergsagel, P. Leif ^{[13
]}

Orlowski, Robert ^{[22
]}

Hinke, Axel ^{[23
]}

Cavo, Michele ^{[24
]}

Attal, Michel ^{[25
]}

机构：

[1] Wilhelminenspital Stadt Wien, Ctr Oncol & Hematol, Dept Med 1, A-1160 Vienna, Austria

[2] Int Myeloma Fdn, SW Oncol Grp, Los Angeles, CA USA

[3] Cedars Sinai Comprehens Canc Ctr, Los Angeles, CA USA

[4] Roswell Pk Canc Inst, Buffalo, NY 14263 USA

[5] Univ Turin, Div Hematol, Azienda Osped Univ S Giovanni Battista, Myeloma Unit, Turin, Italy

[6] Univ Hosp Salamanca, Salamanca, Spain

[7] Univ Arkansas Med Sci, Myeloma Inst Res & Therapy, Little Rock, AR 72205 USA

[8] Erasmus MC, Dept Hematol, Rotterdam, Netherlands

[9] Royal Marsden Hosp, Haematooncol Unit, London SW3 6JJ, England

[10] Alfred Hosp, Clin Haematol Bone Marrow Transplant Dept, Melbourne, Vic, Australia

[11] Dana Farber Canc Inst, Boston, MA 02115 USA

[12] Hosp Claude Huriez, Dept Hematol, Lille, France

[13] Mayo Clin, Div Hematol Oncol, Scottsdale, AZ USA

[14] Univ Hosp, Dept Internal Med 2, Wurzburg, Germany

[15] Haga Hosp, The Hague, Netherlands

[16] Norwegian Univ Sci & Technol, St Olavs Hosp, Dept Hematol, N-7034 Trondheim, Norway

[17] Ankara Univ, Sch Med, Dept Microbiol & Clin Microbiol, Ibn I Sina Hosp, TR-06100 Ankara, Turkey

[18] Univ Hosp, Dept Hematol, Nancy, France

[19] Weill Cornell Med Coll, New York, NY USA

[20] Univ Med Ctr, Utrecht, Netherlands

[21] NCI, Metab Branch, NIH, Bethesda, MD 20892 USA

[22] Univ Texas MD Anderson Canc Ctr, Div Canc Med, Dept Lymphoma Myeloma, Houston, TX 77030 USA

[23] WISP Res Inst, Langenfeld, Germany

[24] S Orsolas Univ Hosp, Bologna Sch Med, Seragnoli Inst Haematol, Bologna, Italy

[25] Hosp Purpan, Serv Hematol, Toulouse, France

来源：

BLOOD | 2012年 / 119卷 / 13期

关键词：

PREDNISONE PLUS THALIDOMIDE; STEM-CELL TRANSPLANTATION; ELDERLY-PATIENTS; RANDOMIZED-TRIAL; INDUCTION THERAPY; IMPROVES SURVIVAL; ORAL MELPHALAN; DEXAMETHASONE; LENALIDOMIDE; INTERFERON;

D O I：

10.1182/blood-2011-11-374249

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Maintaining results of successful induction therapy is an important goal in multiple myeloma. Here, members of the International Myeloma Working Group review the relevant data. Thalidomide maintenance therapy after autologous stem cell transplantation improved the quality of response and increased progression-free survival (PFS) significantly in all 6 studies and overall survival (OS) in 3 of them. In elderly patients, 2 trials showed a significant prolongation of PFS, but no improvement in OS. A meta-analysis revealed a significant risk reduction for PFS/event-free survival and death. The role of thalidomide maintenance after melphalan, prednisone, and thalidomide is not well established. Two trials with lenalidomide maintenance treatment after autologous stem cell transplantation and one study after conventional melphalan, prednisone, and lenalidomide induction therapy showed a significant risk reduction for PFS and an increase in OS in one of the transplant trials. Maintenance therapy with single-agent bortezomib or in combination with thalidomide or prednisone has been studied. One trial revealed a significantly increased OS with a bortezomib-based induction and bortezomib maintenance therapy compared with conventional induction and thalidomide maintenance treatment. Maintenance treatment can be associated with significant side effects, and none of the drugs evaluated is approved for maintenance therapy. Treatment decisions for individual patients must balance potential benefits and risks carefully, as a widely agreed-on standard is not established. (Blood. 2012; 119(13):3003-3015)

引用

页码：3003 / 3015

页数：13

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