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Katodritou E, Kyrtsonis MC, Delimpasi S, Kyriakou D, Symeonidis A, Spanoudakis E, Vasilopoulos G, Anagnostopoulos A, Kioumi A, Zikos P, Aktypi A, Briasoulis E, Megalakaki A, Repousis P, Adamopoulos I, Gogos D, Kotsopoulou M, Pappa V, Papadaki E, Fotiou D, Nikolaou E, Giannopoulou E, Hatzimichael E, Giannakoulas N, Douka V, Kokoviadou K, Timotheatou D, Terpos E. Real-world data on Len/Dex combination at second-line therapy of multiple myeloma: treatment at biochemical relapse is a significant prognostic factor for progression-free survival. Ann Hematol 2018; 97:1671-1682. [PMID: 29756171 PMCID: PMC6097756 DOI: 10.1007/s00277-018-3361-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 05/02/2018] [Indexed: 11/26/2022]
Abstract
We evaluated progression-free survival (PFS) rate of patients treated with lenalidomide/dexamethasone (Len/Dex), the efficacy of the combination, and the prognostic significance of treatment at biochemical vs. clinical relapse on PFS in 207 consecutive myeloma patients treated with Len/Dex in second line, according to routine clinical practice in Greece. First-line treatment included bortezomib-based (63.3%) or immunomodulatory drug-based (34.8%) therapies; 25% of patients underwent autologous stem cell transplantation. Overall response rate was 73.4% (17.8% complete response and 23.7% very good partial response); median time to best response was 6.7 months. Overall, median PFS and 12-month PFS rate was 19.2 months and 67.6%, respectively. 67.5% of patients had biochemical relapse and 32.5% had clinical relapse prior to initiation of Len/Dex. Median PFS was 24 months for patients treated at biochemical relapse vs. 13.2 months for those treated at clinical relapse (HR:0.63, p = 0.006) and the difference remained significant after adjustment for other prognostic factors. Type of relapse was the strongest prognostic factor for PFS in multivariate analysis. These real-world data confirm the efficacy of Len/Dex combination at first relapse; more importantly, it is demonstrated for the first time outside a clinical trial setting that starting therapy with Len/Dex at biochemical, rather than at clinical relapse, is a significant prognostic factor for PFS, inducing a 37% reduction of the probability of disease progression or death.
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Affiliation(s)
- Eirini Katodritou
- Department of Hematology, Theagenion Cancer Hospital, Thessaloniki, Greece.
| | - Marie-Christine Kyrtsonis
- First Department of Propaedeutic Internal Medicine, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Sosana Delimpasi
- Department of Hematology and Bone Marrow Transplantation Unit, Evangelismos Hospital, Athens, Greece
| | - Despoina Kyriakou
- Department of Transfusion Medicine, School of Medicine, University of Thessaly, Larissa, Greece
| | - Argiris Symeonidis
- Department of Internal Medicine, Division of Hematology, University of Patras Medical School, Patras, Greece
| | - Emmanouil Spanoudakis
- Department of Hematology, Dimokrition University of Alexandroupolis, Alexandroupolis, Greece
| | - Georgios Vasilopoulos
- Department of Hematology, School of Medicine, University of Thessaly, Larissa, Greece
| | - Achilles Anagnostopoulos
- Department of Hematology and Bone Marrow Transplantation Unit, George Papanicolaou Hospital, Thessaloniki, Greece
| | - Anna Kioumi
- Department of Hematology, Papageorgiou General Hospital, Thessaloniki, Greece
| | | | | | - Evangelos Briasoulis
- Department of Hematology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | | | | | | | | | | | | | | | | | - Eftychia Nikolaou
- First Department of Propaedeutic Internal Medicine, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Eleftheria Hatzimichael
- Department of Hematology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Nikolaos Giannakoulas
- Department of Hematology, School of Medicine, University of Thessaly, Larissa, Greece
| | - Vassiliki Douka
- Department of Hematology and Bone Marrow Transplantation Unit, George Papanicolaou Hospital, Thessaloniki, Greece
| | - Kyriaki Kokoviadou
- Department of Hematology, Papageorgiou General Hospital, Thessaloniki, Greece
| | | | - Evangelos Terpos
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
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