Could Velcade show the benefit over the autologous retransplantation in relapsing multiple myeloma?
| Authors | |
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| Year of publication | 2007 |
| Type | Article in Proceedings |
| Conference | Haematologica 2007 |
| MU Faculty or unit | |
| Citation | |
| Description | Background. Therapy of relapsing multiple myeloma (MM) is still considered to be experimental. Velcade continues to show benefit in relapsing/refractory myeloma treatment. Design of study: We tested prospectively Velcade in the 1st relaps of MM in comparison with the 2nd autologous transplantation (AT2) or Velcade used after AT2 continued by maintenance therapy. Results were compared using intra-individual analyses [the comparison of time to progression I (TTP I) (after AT1), TTP II (after Velcade to 2nd relaps or after AT2 continued by maintenance therapy) and TTP III (after Velcade used in T2 model) in one patient], therefore inter-individual differences are excluded (T2 model). Patients and Methods. Between April 2004 and October 2006, 11 patients with relapsing/progressing MM after AT1 were treated with Velcade, 6 patients in the 2nd relaps after AT2 continued with maintenance therapy (Thalidomid, CED, IL-2 activated graft, pamidronate or interferon-a). A control group consisted of 53 patients treated with repeated AT continued with the above mentioned maintenance therapy (T2 model). Median follow-up in the control group, in the 1st group (Velcade in the 1st relaps) and in the 2nd group (Velcade after T2 model) was 73.9 months, 61.3 months and 93.3 months respectively. Results. The overall response rate (CR+PR) to Velcade used after AT2 continued with maintenace therapy was 34%, 55% in a group Velcade instead of AT 2 and 88% to AT 2 in T2model. We performed 3 comparisons: 1)TTP I was 20.7 months, TTP II has not been achieved yet in a group of patients treated with Velcade in the 1st relaps (p=0. 656). But in 3/11 (27%) have been TTP II prolonged over TTP I and there are still 5 patiets who have not achieved the 2nd relaps yet. Therefore theese patients can still influence the results and may indicate strong benefit of Velcade used in the 1st relaps. The difference did not reach the statistical signifficance. 2)Median TTP II (to 2nd relaps after AT2 with maintenance therapy) was 5 months, median TTP III (to 3rd relaps after Velcade) in the same group was 6.4 months (p=0.489). In 4/6 (67%) was TTP III longer than TTP II. 3)TTP II (Velcade in 1st relaps) versus TTP II (in T2 model-a control group) - in 4/6 (67%) TTP II was longer than control group TTP II. The difference approaches statistical significance (p=0.078). Conclusions. Velcade has shown benefit in relapsing myeloma post auto transplant and our preliminary data indicate possible benefit of Velcade over AT2. Further prospective follow-up is needed to confirm our prelimiary results. |