The Response to Second-line Induction with Bortezomib and Dexamethasone is Predictive of Long-term Outcomes Prior to High-dose Chemotherapy with Autologous Stem Cell Transplantation for Multiple Myeloma

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概要

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• Objective We retrospectively investigated the efficacy and predictive factors for the treatment outcomes of bortezomib plus dexamethasone (BD) as second-line induction therapy prior to high-dose chemotherapy supported by autologous stem cell transplantation (HDT/ASCT) in multiple myeloma (MM) patients. Methods Sixty-six transplant eligible MM patients treated by the Kyoto Clinical Hematology Study Group between 2006 and 2011 were investigated. Conventional induction chemotherapy, including vincristine, doxorubicin and dexamethasone (VAD) and high-dose dexamethasone (HDD), was used as first-line induction therapy in all patients, seven (10.6%) of whom attained a very good partial response (VGPR). Of the 59 patients who did not attain VGPR with VAD or HDD, 33 were given BD as second-line induction therapy prior to HDT/ASCT. Results Patients not treated with BD induction showed an overall response rate (ORR, i.e., better than partial response) of 85.3% after induction therapy, while the ORR of patients treated with BD induction improved from 42.4% after conventional induction therapy to 84.8% after BD. The overall survival (OS) and progression-free survival (PFS) of patients not treated with BD induction were not significantly influenced by the response to induction therapy. Among the patients treated with BD, failure in attaining VGPR prior to ASCT was associated with a significantly shorter PFS and it also tended to show a shorter OS, while the disease stage and achievement of a complete response after HDT/ASCT had no impact on OS or PFS. Conclusion The achievement of at least VGPR with second-line BD induction therapy is a prerequisite for attaining longer OS and PFS after HDT/ASCT.

著者

• Uoshima Nobuhiko

  Department Of Hematology Matsushita Memorial Hospital

• OKANO Akira

  Department of Animal Reproduction, National Institute of Animal Industry

• Kuroda Junya

  Division Of Hematology And Oncology Department Of Medicine Kyoto Prefectural University Of Medicine

• Kaneko Hiroto

  Department Of Hematology Aiseikai-yamashina Hospital

• Horiike Shigeo

  Division Of Hematology And Oncology Department Of Medicine Kyoto Prefectural University Of Medicine

• MATSUMOTO Yosuke

  Division of Hematology and Oncology, Department of Medicine, Kyoto Prefectural University of Medicin

• Uchiyama Hitoji

  Division Of Hematology And Oncology Department Of Medicine Kyoto Prefectural University Of Medicine

• Tsutsumi Yasuhiko

  Department Of Psychiatry & Behavioral Science Tokai University School Of Medicine

• Shimazaki Chihiro

  Department Of Hematology Kyoto Social Insurance Hospital

• Kamitsuji Yuri

  Department Of Hematology Matsushita Memorial Hospital

• Kobayashi Tsutomu

  Division Of Hematology And Oncology Department Of Medicine Kyoto Prefectural University Of Medicine

• Akaogi Teruaki

  Department Of Hematology Kyoto Second Red Cross Hospital

• Iwai Toshiki

  Department Of Hematology Kyoto First Red Cross Hospital

• Hatsuse Mayumi

  Department Of Hematology Kyoto Social Insurance Hospital

• Murakami Satoshi

  Department Of Applied Chemistry Faculty Of Engineering

• Takahashi Ryoichi

  Department Of Agriculture Government Research Institute

• Taniwaki Masafumi

  Division Of Hematology And Oncology Department Of Internal Medicine St. Marianna University School O

• Kobayashi Yutaka

  Department Of Applied Physics Fukui University

• Shimizu Daisuke

  Department Of Breast And Thyroid Surgery Yokohama City University Medical Center

• FUCHIDA Shin-ichi

  Department of Hematology, Social Insurance Kyoto Hospital

• Shimazaki Chihiro

  Department of Hematology, Kyoto Social Insurance Hospital, Japan

• Uchiyama Hitoji

  Division of Hematology and Oncology, Department of Medicine, Kyoto Prefectural University of Medicine, Japan

• Kawata-Iida Eri

  Department of Hematology, Kyoto Second Red Cross Hospital, Japan

• Nakao Mitsushige

  Department of Medicine, Otsu Municipal Hospital, Japan

• Nakao Mitsushige

  Department of Medicine, Otsu Municipal Hospital

• Kaneko Hiroto

  Department of Hematology, Kyoto First Red Cross Hospital, Japan

• Iwai Toshiki

  Department of Hematology, Kyoto First Red Cross Hospital, Japan

• Fuchida Shin-ichi

  Department of Hematology, Kyoto Social Insurance Hospital, Japan

• Tsutsumi Yasuhiko

  Department of Hematology, Kyoto First Red Cross Hospital, Japan

• Akaogi Teruaki

  Department of Hematology, Kyoto Second Red Cross Hospital, Japan

• Okano Akira

  Department of Hematology, Kyoto Social Insurance Hospital, Japan

• Kobayashi Yutaka

  Department of Hematology, Kyoto Second Red Cross Hospital, Japan

• OKANO Akira

  Department of Animal Breeding and Reproduction, National Institute of Livestock and Grassland Science

• Kobayashi Tsutomu

  Division of Hematology and Oncology, Department of Medicine, Kyoto Prefectural University of Medicine, Japan

• Shimizu Daisuke

  Department of Hematology, Kyoto Second Red Cross Hospital, Japan

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