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    Triplet Therapy, Transplantation, and Maintenance until Progression in Myeloma

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    Author
    Richardson, Paul G
    Jacobus, 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
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    Affiliation
    Department of Bone Marrow Transplant and Cellular Therapy, University of Arizona
    Issue Date
    2022-06-05
    
    Metadata
    Show full item record
    Publisher
    Massachussetts Medical Society
    Citation
    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 Medicine
    Rights
    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 2022
    EISSN
    1533-4406
    PubMed ID
    35660812
    DOI
    10.1056/NEJMoa2204925
    Version
    Final published version
    ae974a485f413a2113503eed53cd6c53
    10.1056/NEJMoa2204925
    Scopus Count
    Collections
    UA Faculty Publications

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