TY - JOUR
T1 - Single-agent lenalidomide maintenance after upfront autologous stem cell transplant for newly diagnosed multiple myeloma
T2 - The MD Anderson experience
AU - Pasvolsky, Oren
AU - Milton, Denái R.
AU - Masood, Adeel
AU - Sami, Sophiya S.
AU - Tanner, Mark R.
AU - Bashir, Qaiser
AU - Srour, Samer
AU - Saini, Neeraj
AU - Lin, Paul
AU - Ramdial, Jeremy
AU - Nieto, Yago
AU - Saeed, Arsalan
AU - Lee, Hans C.
AU - Patel, Krina K.
AU - Kebriaei, Partow
AU - Thomas, Sheeba K.
AU - Weber, Donna M.
AU - Orlowski, Robert Z.
AU - Shpall, Elizabeth J.
AU - Champlin, Richard E.
AU - Qazilbash, Muzaffar H.
N1 - Funding Information:
This work was supported in part by the Cancer Center Support Grant (NCI Grant P30 CA016672); RZO, the Florence Maude Thomas Cancer Research Professor, would like to acknowledge support from the Leukemia & Lymphoma Society (SCOR‐12206‐17), the Dr. Miriam and Sheldon G. Adelson Medical Research Foundation, and the Riney Family Multiple Myeloma Research Fund at MD Anderson from the Paula and Rodger Riney Foundation.
Publisher Copyright:
© 2023 Wiley Periodicals LLC.
PY - 2023/10
Y1 - 2023/10
N2 - The optimal duration of lenalidomide (Len) maintenance for patients with multiple myeloma (MM) after autologous stem cell transplantation (autoHCT) is unknown. We conducted a retrospective single-center analysis of adult MM patients that received upfront autoHCT between 2005 and 2021, followed by single-agent Len maintenance. A total of 1167 patients were included with a median age of 61.4 (range 25.4–82.3) years, and high-risk chromosomal abnormalities in 19%. Median duration of maintenance was 22.3 (range 0.03–139.6) months. After a median follow-up of 47.9 (range 2.9–171.7) months, median PFS and OS for the entire cohort were 56.6 (95% CI 48.2–61.4) months and 111.3 (95% CI 101.7–121.5) months, respectively. In MVA, high-risk cytogenetics was associated with a worse PFS (HR 1.91) and OS (HR 1.73) (p <.001 for both). Use of KRD induction and achievement of MRD-negative ≥ VGPR before autoHCT were associated with an improved PFS (HR 0.53 and HR 0.57, respectively; p <.001 for both). Longer maintenance duration, even with a 5-year cutoff, was associated with superior PFS and OS (HR 0.17 and 0.12, respectively; p <.001 for both). A total of 106 patients (9%) developed a second primary malignancy (SPM), mostly solid tumors (39%) and myeloid malignancies (30%). Longer maintenance duration was associated with a higher risk of SPM, reaching statistical significance after >2 years (odds ratio 2.25; p <.001). In conclusion, outcomes with Len maintenance were comparable to those reported in large clinical trials. Longer duration of maintenance, even beyond 5 years, was associated with improved survival.
AB - The optimal duration of lenalidomide (Len) maintenance for patients with multiple myeloma (MM) after autologous stem cell transplantation (autoHCT) is unknown. We conducted a retrospective single-center analysis of adult MM patients that received upfront autoHCT between 2005 and 2021, followed by single-agent Len maintenance. A total of 1167 patients were included with a median age of 61.4 (range 25.4–82.3) years, and high-risk chromosomal abnormalities in 19%. Median duration of maintenance was 22.3 (range 0.03–139.6) months. After a median follow-up of 47.9 (range 2.9–171.7) months, median PFS and OS for the entire cohort were 56.6 (95% CI 48.2–61.4) months and 111.3 (95% CI 101.7–121.5) months, respectively. In MVA, high-risk cytogenetics was associated with a worse PFS (HR 1.91) and OS (HR 1.73) (p <.001 for both). Use of KRD induction and achievement of MRD-negative ≥ VGPR before autoHCT were associated with an improved PFS (HR 0.53 and HR 0.57, respectively; p <.001 for both). Longer maintenance duration, even with a 5-year cutoff, was associated with superior PFS and OS (HR 0.17 and 0.12, respectively; p <.001 for both). A total of 106 patients (9%) developed a second primary malignancy (SPM), mostly solid tumors (39%) and myeloid malignancies (30%). Longer maintenance duration was associated with a higher risk of SPM, reaching statistical significance after >2 years (odds ratio 2.25; p <.001). In conclusion, outcomes with Len maintenance were comparable to those reported in large clinical trials. Longer duration of maintenance, even beyond 5 years, was associated with improved survival.
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U2 - 10.1002/ajh.27029
DO - 10.1002/ajh.27029
M3 - Article
C2 - 37461327
AN - SCOPUS:85165290844
SN - 0361-8609
VL - 98
SP - 1571
EP - 1578
JO - American journal of hematology
JF - American journal of hematology
IS - 10
ER -