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A number of studies suggest that there is a right and wrong way to proceed with initial therapy and transplant eligibility for patients with multiple myeloma.
Sundar Jagannath, MD
For newly diagnosed multiple myeloma patients, clinical oncologists have a number of important decisions to make regarding the course of treatment, and while there are some questions that might not have definitive answers, a number of studies suggest that there is a right and wrong way to proceed with initial therapy and transplant eligibility.
Sundar Jagannath, MD, director of the Multiple Myeloma Program at the Tisch Cancer Institute at Mount Sinai Medical Center in New York City, presented a review of this information at the 16th Annual International Congress on Hematologic Malignancies.
In his presentation, Jagannath said that many treating oncologists might question whether to provide bortezomib (Velcade) plus melphalan-prednisone (VMP) as a front-line treatment for multiple myeloma patients instead of melphalan-prednisone (MP) alone. However, based on the results of the phase III VISTA trial presented at the American Society of Hematology meeting in 2011, Jagannath said that adding bortezomib is the right course of action for these patients (View Abstract). The VISTA study showed that after 5 years of follow-up, patients who received VMP experienced a 13.3-month increase in overall survival (OS) compared with patients who only received MP. After a median follow up of 60.1 months, median OS was 56.4 months for patients who received VMP versus to 43.1 months for patients who received MP (HR 0.695, P = .0004). There was a 31% reduced risk of death with the VMP regimen.
"This suggests that there is benefit to using a more aggressive therapy approach upfront," Jagannath said.
Since stem cell transplantation is frequently used as a treatment option, Jagannath said that treating physicians should consider whether the patient is eligible to receive a transplant before proceeding with chemotherapy. Historically, high-dose melphalan coupled with an autologous stem cell transplantation has resulted in higher response rates and longer remission times than traditional chemotherapy. However, some studies have suggested that newer therapies such as bortezomib, thalidomide, and lenalidomide could affect transplantation outcomes.