Effects of induction with novel agents versus conventional chemotherapy on mobilization and autologous stem cell transplant outcomes in multiple myeloma

被引:13
|
作者
Benson, Don M., Jr. [1 ,2 ,3 ,4 ,5 ]
Panzner, Kathryn [3 ]
Hamadani, Mehdi [1 ]
Hofmeister, Craig C. [1 ,2 ,3 ,4 ,5 ]
Bakan, Courtney E. [5 ]
Smith, Megan K. [5 ]
Elder, Pat [2 ,4 ]
Krugh, David [2 ,4 ]
O'Donnell, Lynn [2 ,4 ]
Devine, Steven M. [1 ,2 ,3 ,4 ,5 ]
机构
[1] Ohio State Univ, Div Hematol & Oncol, Columbus, OH 43210 USA
[2] Ohio State Univ, Blood & Marrow Transplant Program, Columbus, OH 43210 USA
[3] Ohio State Univ, Dept Internal Med, Columbus, OH 43210 USA
[4] Ohio State Univ, Arthur G James Canc Hosp & Solove Res Inst, Columbus, OH 43210 USA
[5] Ohio State Univ, Ctr Comprehens Canc, Columbus, OH 43210 USA
关键词
Multiple myeloma; stem cell transplant; stem cell mobilization; LENALIDOMIDE PLUS DEXAMETHASONE; HIGH-DOSE DEXAMETHASONE; BLOOD PROGENITOR CELLS; COMBINATION THERAPY; COLLECTION; BORTEZOMIB; CYCLOPHOSPHAMIDE; THALIDOMIDE; MELPHALAN; IMPACT;
D O I
10.3109/10428190903480728
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Multiple myeloma (MM) is the top indication for high-dose chemotherapy (HDC) with autologous stem cell transplantation (SCT), a strategy which improves progression-free survival and potentially overall survival (OS). Novel induction regimens incorporating the immunomodulatory (IMID) agents, such as thalidomide and lenalidomide and the proteosome inhibitor bortezomib improve response rates and survival for newly diagnosed patients. Recent data temper enthusiasm for these treatments by illustrating difficulty in some circumstances with mobilizing CD34(+) hematopoietic stem cells for subsequent HDC/SCT. We compare conventional induction regimens with novel agent-based induction strategies and the associated effects on stem cell mobilization and HDC/SCT outcome in 224 patients. Although patients exposed to novel agent inductions collected generally fewer CD34(+) cells than patients induced with chemotherapy, these differences did not translate into adverse consequences with subsequent HDC/SCT. We show that an improvement in OS after HDC/SCT may be related to induction therapy with novel agents as opposed to chemotherapy. Our data extrapolate on prior work and expand on ongoing controversies about optimal induction regimens for patients with MM planned for subsequent HDC/SCT and optimal sequencing of therapies.
引用
收藏
页码:243 / 251
页数:9
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