Long-Term Follow-Up Results of Lenalidomide, Bortezomib, and Dexamethasone Induction Therapy and Risk-Adapted Maintenance Approach in Newly Diagnosed Multiple Myeloma
Top Cited Papers
- 10 June 2020
- journal article
- research article
- Published by American Society of Clinical Oncology (ASCO) in Journal of Clinical Oncology
- Vol. 38 (17), 1928-+
- https://doi.org/10.1200/JCO.19.02515
Abstract
PURPOSEThe combination of lenalidomide, bortezomib, and dexamethasone (RVD) is a highly effective and convenient induction regimen for both transplantation-eligible and -ineligible patients with myeloma. Here, we present the largest cohort of patients consecutively treated with RVD induction therapy followed by risk-adapted maintenance therapy with the longest follow-up and important information on long-term outcomes.PATIENTS AND METHODSWe describe 1,000 consecutive patients with newly diagnosed myeloma treated with RVD induction therapy from January 2007 until August 2016. Demographic and clinical characteristics and outcomes data were obtained from our institutional review board-approved myeloma database. Responses and progression were evaluated per International Myeloma Working Group Uniform Response Criteria.RESULTSThe overall response rate was 97.1% after induction therapy and 98.5% after transplantation, with 89.9% of patients achieving a very good partial response (VGPR) or better and 33.3% achieving stringent complete response after transplantation at a median follow-up time of 67 months. The estimated median progression-free survival time was 65 months (95% CI, 58.7 to 71.3 months) for the entire cohort, 40.3 months (95% CI, 33.5 to 47 months) for high-risk patients, and 76.5 months (95% CI, 66.9 to 86.2 months) for standard-risk patients. The median overall survival (OS) time for the entire cohort was 126.6 months (95% CI, 113.3 to 139.8 months). The median OS for high-risk patients was 78.2 months (95% CI, 62.2 to 94.2 months), whereas it has not been reached for standard-risk patients. Five-year OS rates for high-risk and standard-risk patients were 57% and 81%, respectively, and the 10-year OS rates were 29% and 58%, respectively.CONCLUSIONRVD is an induction regimen that delivers high response rates (VGPR or better) in close to 90% of patients after transplantation, and risk-adapted maintenance can deliver unprecedented long-term outcomes. This study includes the largest cohort of patients treated with RVD reported to date with long follow-up and demonstrates the ability of 3-drug induction regimens in patients with newly diagnosed multiple myeloma to result in a substantial survival benefit.This publication has 11 references indexed in Scilit:
- Outcomes of Transplant-Eligible Newly Diagnosed Ultra-High Risk Myeloma Patients Treated in the NCRI Myeloma XI Trial Indicate the Need for Early Treatment Stratification and Novel Treatment ApproachesBlood, 2019
- Predictive Model of Early Relapse in Newly Diagnosed Multiple Myeloma: Analysis from a Pooled DatasetBlood, 2019
- With Equal Access, African Americans with Non-del17p Multiple Myeloma Have Superior Overall Survival, but del17p Still Carries Poor Prognosis across Race: A VA StudyBlood, 2019
- Bortezomib, lenalidomide, and dexamethasone as induction therapy prior to autologous transplant in multiple myelomaBlood, 2019
- Lenalidomide, Bortezomib, and Dexamethasone with Transplantation for MyelomaThe New England Journal of Medicine, 2017
- Autologous Transplantation and Maintenance Therapy in Multiple MyelomaThe New England Journal of Medicine, 2014
- Consolidation and maintenance therapy with lenalidomide, bortezomib and dexamethasone (RVD) in high-risk myeloma patientsLeukemia, 2013
- Lenalidomide Maintenance after Stem-Cell Transplantation for Multiple MyelomaThe New England Journal of Medicine, 2012
- Lenalidomide after Stem-Cell Transplantation for Multiple MyelomaThe New England Journal of Medicine, 2012
- Racial disparities in incidence and outcome in multiple myeloma: a population-based studyBlood, 2010