Authors: S. Pereira, L. M. Sarmento, M. Leal Fernandes, R. Brito, A. Monteiro, G. Ferreira, F. Costa, A. Botelho de Sousa
Published: 2019-06-17
DOI: 10.1097/01.hs9.0000567016.08193.f9
Source: Full article
Background:The first‐line strategy consensually accepted as the most effective in MM is a triplet PTI followed by autologous hematopoietic progenitor transplantation (AHPT). The proportion of patients eligible for AHPT has been steadily increasing as its safety and efficacy are documented in older patients. In this context, the duration of PTI gains relevance in real life: the standard recommendation of 3‐4 cycles is defined based on the unproven statement that a longer PTI may have negative effects on patient outcome, a conviction recently denied by the evidence published by Chakraborty et. al. (2018). Additionally, the possibility of prolonging PTI, although potentially associated with undesirable toxicity, may be beneficial in improving response depth prior to AHPT and sustain the response until transplantation is possible according to the transplantation center schedule.Aims:Evaluate the impact of PTI duration on the 3 month (mo)‐CR rate post‐AHPT, on median progression‐free survival (mPFS) and overall survival (OS) in MM patients transplanted at our center over a 12‐year period.MethodsData from 273 MM patients consecutively transplanted after PTI between September 2005 and March 2018 was collected. 104 patients were excluded from the analysis: 75 due to > 12 mo interval from PTI beginning to AHTP, 10 due to > 1 PTI line prior to AHPT and 19 due to missing data.Results:We analyzed 169 patients, median age 61 (30‐73), comparing those treated with PTI up to 4c (n = 70) with those subjected to > 4c (n = 99). The proportion of patients with unfavorable ISS, high‐risk cytogenetics, or that received doublet PTI did not differ among the groups. With a median follow‐up of 40mo, the 3mo CR rate post‐AHPT was similar between the 2 groups (41 vs 51%, p = 0.2) as were the mPFS (37 vs 33mo, p = 0.3) and the 5y OS (68 vs 59%, p = 0.1). We also explored the influence of PTI duration in particular subpopulations: high‐risk cytogenetics; VGPR pre‐AHPT; or treated with doublet PTI (vs triplet). No significant differences were found, except for the mPFS in the subgroup treated with VCD (NA vs 27mo, p = 0.02).Summary/Conclusion:Our results suggest that a prolonged PTI beyond 4c does not improve post‐AHPT outcomes. These findings are similar to those of the Mayo Clinic study. Nevertheless, the conclusion we find most relevant is that a prolonged PTI, which may be required to deepen pre‐AHPT response or to sustain response up to transplantation, is not more deleterious in terms of PFS and OS.