Page 232 - Haematologica April 2020

Plasma Cell DIsorders
Ferrata Storti Foundation
Haematologica 2020 Volume 105(4):1074-1080
First-line therapy with either bortezomib- melphalan-prednisone or lenalidomide- dexamethasone followed by lenalidomide for transplant-ineligible multiple myeloma patients: a pooled analysis of two randomized trials
Alessandra Larocca,1 Roberto Mina,1 Massimo Offidani,2 Anna Marina Liberati,3 Antonio Ledda,4 Francesca Patriarca,5 Andrea Evangelista,6 Stefano Spada,1 Giulia Benevolo,7 Daniela Oddolo,1 Vanessa Innao,8 Clotilde Cangiolosi,9 Annalisa Bernardini,1 Pellegrino Musto,10 Valeria Amico,11 Vincenzo Fraticelli,12 Laura Paris,13 Nicola Giuliani,14 Antonietta Pia Falcone,15 Renato Zambello,16 Lorenzo De Paoli,17 Alessandra Romano,18 Antonio Palumbo,1* Vittorio Montefusco,19 Roman Hájek,20,21 Mario Boccadoro1 and Sara Bringhen1
1Myeloma Unit, Division of Hematology, University of Torino, Azienda-Ospedaliero Universitaria (AOU) Città della Salute e della Scienza di Torino, Torino, Italy; 2Clinica di Ematologia, AOU Ospedali Riuniti di Ancona, Ancona, Italy; 3Università degli Studi di Perugia, Azienda Ospedaliera (AO) Santa Maria, Terni, Italy; 4Ematologia/CTMO Ospedale “A. Businco”, Cagliari, Italy; 5Udine University Hospital, DAME, University of Udine, Udine, Italy; 6Unit of Clinical Epidemiology, AOU Città della Salute e della Scienza di Torino e CPO, Piemonte, Torino, Italy; 7Hematology, Città della Salute e della Scienza, Torino, Italy; 8U.O.C. Ematologia AOU G. Martino, Messina, Italy; 9AO Villa Sofia-Cervello, Divisione Ematologia I UTMO, Palermo, Italy; 10Unit of Haematology and Stem Cell Transplantation, IRCCS-CROB, Referral Cancer Center of Basilicata, Rionero in Vulture, Italy; 11DH-Ematologico AO "S.Pio", Benevento, Italy; 12Fondazione “Giovanni Paolo II”, Unità Operativa Complessa di Oncoematologia, Campobasso, Italy; 13Hematology and Bone Marrow Transplant Unit, Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Italy; 14Department of Medicine and Surgery, University of Parma, Parma, Italy; 15Ematologia, IRCCS “Casa Sollievo della Sofferenza” Hospita, San Giovanni Rotondo, Italy; 16Padova University School of Medicine, Hematology and Clinical Immunology, Padova, Italy; 17Università del Piemonte Orientale A. Avogadro, Novara, Italy; 18Division of Hematology, AOU Policlinico, Department of Surgery and Medical Specialties, University of Catania, Italy; 19Hematology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy; 20Department of Hematooncology University Hospital Ostrava, Ostrava, Czech Republic and 21Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
*Currently a GlaxoSmithKline AG employee.
ABSTRACT
Bortezomib-melphalan-prednisone (VMP) and continuous lenalido- mide-dexamethasone (Rd) represent the standard treatment of transplant-ineligible patients with newly diagnosed multiple myeloma (MM). To date, no randomized trial has compared VMP to Rd, and there is no evidence of the optimal treatment for newly diagnosed MM, particularly in patients with high-risk cytogenetics [del(17p), t(4;14) or t(14;16)]. We pooled together data from patients with newly diag- nosed MM treated with VMP or Rd induction followed by lenalidomide maintenance 10 mg (Rd-R) enrolled in the GIMEMA-MM-03-05 and EMN01 trials, to evaluate the efficacy of these treatments in different subgroups of patients, focusing on those with standard- and high-risk cytogenetics. Overall, 474 patients were analyzed (VMP: 257 patients; Rd-R: 217 patients). No differences in progression-free survival (hazard ratio=0.96) and overall survival (hazard ratio=1.08) were observed between standard-risk patients treated with VMP or Rd-R, whereas among the high-risk patients, the probabilities of progression (hazard ratio=0.54) and death (hazard ratio=0.73) were lower in the patients treated with VMP than in those treated with Rd-R. In particular, stan- dard-risk patients >75 years benefited less from VMP than from Rd-R
Correspondence:
ALESSANDRA LAROCCA
alelarocca@hotmail.com
Received: February 27, 2019. Accepted: June 25, 2019. Pre-published: June 27, 2019.
doi:10.3324/haematol.2019.220657
Check the online version for the most updated information on this article, online supplements, and information on authorship & disclosures: www.haematologica.org/content/105/4/1074
©2020 Ferrata Storti Foundation
Material published in Haematologica is covered by copyright. All rights are reserved to the Ferrata Storti Foundation. Use of published material is allowed under the following terms and conditions: https://creativecommons.org/licenses/by-nc/4.0/legalcode. Copies of published material are allowed for personal or inter- nal use. Sharing published material for non-commercial pur- poses is subject to the following conditions: https://creativecommons.org/licenses/by-nc/4.0/legalcode, sect. 3. Reproducing and sharing published material for com- mercial purposes is not allowed without permission in writing from the publisher.
1074
haematologica | 2020; 105(4)
ARTICLE