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Karam D, Gertz M, Lacy M, Dispenzieri A, Hayman S, Dingli D, Buadi F, Kapoor P, Kourelis T, Warsame R, Hogan W, Kumar S. Impact of maintenance therapy post autologous stem cell transplantation for multiple myeloma in early and delayed transplant. Bone Marrow Transplant 2022; 57:803-809. [PMID: 35297404 DOI: 10.1038/s41409-022-01631-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 02/22/2022] [Accepted: 02/24/2022] [Indexed: 11/09/2022]
Abstract
Based on phase 3 trials, maintenance therapy after autologous stem cell transplantation (ASCT) has become the standard of care in multiple myeloma (MM). We examined the trends in maintenance therapy in a large group of patients (2530) transplanted at a single institution over two decades. Majority (n = 1958; 77%) had an ASCT within 12 months of diagnosis (early ASCT). Maintenance was employed in 39% of the patients; 42% among early ASCT and 30.5% among delayed ASCT. Most common maintenance approach was an IMiD (61%), followed by a PI (31%), or a PI + IMiD (4%). Patients with high-risk FISH received PI-based maintenance more frequently. The PFS was superior with maintenance (36 vs. 22 months, p < 0.001); 37 vs. 25 months for early ASCT (p < 0.001) and 29 vs. 17 months for delayed ASCT (p = 0.0008). OS from ASCT was higher with maintenance for the whole cohort at 93 vs. 73 months (p < 0.001). OS from diagnosis was also better for the whole cohort with maintenance therapy, 112 vs. 93 months (p < 0.001). The improvement in PFS and OS was seen in high-risk and standard risk disease. The experience with maintenance therapy post ASCT for myeloma in a non-clinical trial setting confirms the findings from the phase 3 trials.
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Affiliation(s)
- Dhauna Karam
- Department of Community Internal Medicine, Mayo Clinic Health System, Albert Lea, MN, USA
| | - Morie Gertz
- Department of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Martha Lacy
- Department of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | - Suzanne Hayman
- Department of Hematology, Mayo Clinic, Rochester, MN, USA
| | - David Dingli
- Department of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Francis Buadi
- Department of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | | | - Rahma Warsame
- Department of Hematology, Mayo Clinic, Rochester, MN, USA
| | - William Hogan
- Department of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Shaji Kumar
- Department of Hematology, Mayo Clinic, Rochester, MN, USA.
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Zamagni E, Tacchetti P, Deias P, Patriarca F. The Role of Monoclonal Antibodies in Smoldering and Newly Diagnosed Transplant-Eligible Multiple Myeloma. Pharmaceuticals (Basel) 2020; 13:E451. [PMID: 33321731 PMCID: PMC7764080 DOI: 10.3390/ph13120451] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 11/30/2020] [Accepted: 12/04/2020] [Indexed: 12/13/2022] Open
Abstract
The recent introduction of monoclonal antibodies (MoAbs), with several cellular targets, such as CD-38 (daratumumab and isatuximab) and SLAM F7 (elotuzumab), differently combined with other classes of agents, has significantly extended the outcomes of patients with multiple myeloma (MM) in different phases of the disease. Initially used in advanced/refractory patients, different MoAbs combination have been introduced in the treatment of newly diagnosed transplant eligible patients (NDTEMM), showing a significant improvement in the depth of the response and in survival outcomes, without a significant price in terms of toxicity. In smoldering MM, MoAbs have been applied, either alone or in combination with other drugs, with the goal of delaying the progression to active MM and restoring the immune system. In this review, we will focus on the main results achieved so far and on the main on-going trials using MoAbs in SMM and NDTEMM.
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Affiliation(s)
- Elena Zamagni
- Istituto di Ematologia “Seragnoli”, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy;
| | - Paola Tacchetti
- Istituto di Ematologia “Seragnoli”, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy;
| | - Paola Deias
- Clinica Ematologica e Unità di Terapie Cellulari, Azienda Sanitaria Universitaria Friuli Centrale, 33100 Udine, Italy; (D.P.); (P.F.)
| | - Francesca Patriarca
- Clinica Ematologica e Unità di Terapie Cellulari, Azienda Sanitaria Universitaria Friuli Centrale, 33100 Udine, Italy; (D.P.); (P.F.)
- Dipartimento di Area Medica, Università di Udine, 33100 Udine, Italy
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