Triplet Therapy, Transplantation, and Maintenance until Progression in Myeloma
Author
Richardson, Paul GJacobus, Susanna J
Weller, Edie A
Hassoun, Hani
Lonial, Sagar
Raje, Noopur S
Medvedova, Eva
McCarthy, Philip L
Libby, Edward N
Voorhees, Peter M
Orlowski, Robert Z
Anderson, Larry D
Zonder, Jeffrey A
Milner, Carter P
Gasparetto, Cristina
Agha, Mounzer E
Khan, Abdullah M
Hurd, David D
Gowin, Krisstina
Kamble, Rammurti T
Jagannath, Sundar
Nathwani, Nitya
Alsina, Melissa
Cornell, R Frank
Hashmi, Hamza
Campagnaro, Erica L
Andreescu, Astrid C
Gentile, Teresa
Liedtke, Michaela
Godby, Kelly N
Cohen, Adam D
Openshaw, Thomas H
Pasquini, Marcelo C
Giralt, Sergio A
Kaufman, Jonathan L
Yee, Andrew J
Scott, Emma
Torka, Pallawi
Foley, Amy
Fulciniti, Mariateresa
Hebert, Kyle
Samur, Mehmet K
Masone, Kelly
Maglio, Michelle E
Zeytoonjian, Andrea A
Nadeem, Omar
Schlossman, Robert L
Laubach, Jacob P
Paba-Prada, Claudia
Ghobrial, Irene M
Perrot, Aurore
Moreau, Philippe
Avet-Loiseau, Hervé
Attal, Michel
Anderson, Kenneth C
Munshi, Nikhil C
Affiliation
Department of Bone Marrow Transplant and Cellular Therapy, University of ArizonaIssue Date
2022-06-05
Metadata
Show full item recordPublisher
Massachussetts Medical SocietyCitation
Richardson, P. G., Jacobus, S. J., Weller, E. A., Hassoun, H., Lonial, S., Raje, N. S., Medvedova, E., McCarthy, P. L., Libby, E. N., Voorhees, P. M., Orlowski, R. Z., Anderson, L. D., Jr., Zonder, J. A., Milner, C. P., Gasparetto, C., Agha, M. E., Khan, A. M., Hurd, D. D., Gowin, K., … Munshi, N. C. (2022). Triplet Therapy, Transplantation, and Maintenance until Progression in Myeloma. New England Journal of Medicine, 387(2), 132–147.Journal
New England Journal of MedicineRights
Copyright © 2022 Massachusetts Medical Society.Collection Information
This item from the UA Faculty Publications collection is made available by the University of Arizona with support from the University of Arizona Libraries. If you have questions, please contact us at repository@u.library.arizona.edu.Abstract
BACKGROUND In patients with newly diagnosed multiple myeloma, the effect of adding autologous stem-cell transplantation (ASCT) to triplet therapy (lenalidomide, bortezomib, and dexamethasone [RVD]), followed by lenalidomide maintenance therapy until disease progression, is unknown. METHODS In this phase 3 trial, adults (18 to 65 years of age) with symptomatic myeloma received one cycle of RVD. We randomly assigned these patients, in a 1:1 ratio, to receive two additional RVD cycles plus stem-cell mobilization, followed by either five additional RVD cycles (the RVD-alone group) or high-dose melphalan plus ASCT followed by two additional RVD cycles (the transplantation group). Both groups received lenalidomide until disease progression, unacceptable side effects, or both. The primary end point was progression-free survival. RESULTS Among 357 patients in the RVD-alone group and 365 in the transplantation group, at a median follow-up of 76.0 months, 328 events of disease progression or death occurred; the risk was 53% higher in the RVD-alone group than in the transplantation group (hazard ratio, 1.53; 95% confidence interval [CI], 1.23 to 1.91; P<0.001); median progression-free survival was 46.2 months and 67.5 months. The percentage of patients with a partial response or better was 95.0% in the RVD-alone group and 97.5% in the transplantation group (P=0.55); 42.0% and 46.8%, respectively, had a complete response or better (P=0.99). Treatment-related adverse events of grade 3 or higher occurred in 78.2% and 94.2%, respectively; 5-year survival was 79.2% and 80.7% (hazard ratio for death, 1.10; 95% CI, 0.73 to 1.65). CONCLUSIONS Among adults with multiple myeloma, RVD plus ASCT was associated with longer progression-free survival than RVD alone. No overall survival benefit was observed.Note
6 month embargo; published online: 05 June 2022EISSN
1533-4406PubMed ID
35660812Version
Final published versionae974a485f413a2113503eed53cd6c53
10.1056/NEJMoa2204925