Optimising the value of immunomodulatory drugs during induction and maintenance in transplant ineligible patients with newly diagnosed multiple myeloma: results from Myeloma XI, a multicentre, open-label, randomised, Phase III trial.
Age Factors
Aged
Aged, 80 and over
Antineoplastic Combined Chemotherapy Protocols
/ therapeutic use
Bortezomib
/ administration & dosage
Consolidation Chemotherapy
Cyclophosphamide
/ administration & dosage
Dexamethasone
/ administration & dosage
Female
Humans
Immunologic Factors
/ therapeutic use
Immunomodulation
Kaplan-Meier Estimate
Lenalidomide
/ administration & dosage
Male
Middle Aged
Multiple Myeloma
/ drug therapy
Remission Induction
Thalidomide
/ administration & dosage
Treatment Outcome
immunomodulatory agent
lenalidomide
myeloma
thalidomide
transplant-ineligible
Journal
British journal of haematology
ISSN: 1365-2141
Titre abrégé: Br J Haematol
Pays: England
ID NLM: 0372544
Informations de publication
Date de publication:
03 2021
03 2021
Historique:
received:
01
04
2020
accepted:
13
06
2020
pubmed:
14
7
2020
medline:
10
8
2021
entrez:
14
7
2020
Statut:
ppublish
Résumé
Second-generation immunomodulatory agents, such as lenalidomide, have a more favourable side-effect profile than the first-generation thalidomide, but their optimum combination and duration for patients with newly diagnosed transplant-ineligible myeloma (ND-TNE-MM) has not been defined. The most appropriate delivery and dosing regimens of these therapies for patients at advanced age and frailty status is also unclear. The Myeloma XI study compared cyclophosphamide, thalidomide and dexamethasone (CTDa) to cyclophosphamide, lenalidomide and dexamethasone (CRDa) as induction therapy, followed by a maintenance randomisation between ongoing therapy with lenalidomide or observation for patients with ND-TNE-MM. CRDa deepened response but did not improve progression-free (PFS) or overall survival (OS) compared to CTDa. However, analysis by age group highlighted significant differences in tolerability in older, frailer patients that may have limited treatment delivery and impacted outcome. Deeper responses and PFS and OS benefits with CRDa over CTDs were seen in patients aged ≤70 years, with an increase in toxicity and discontinuation observed in older patients. Our results highlight the importance of considering age and frailty in the approach to therapy for patients with ND-TNE-MM, highlighting the need for prospective validation of frailty adapted therapy approaches, which may improve outcomes by tailoring treatment to the individual.
Substances chimiques
Immunologic Factors
0
Thalidomide
4Z8R6ORS6L
Bortezomib
69G8BD63PP
Dexamethasone
7S5I7G3JQL
Cyclophosphamide
8N3DW7272P
Lenalidomide
F0P408N6V4
Types de publication
Clinical Trial, Phase III
Comparative Study
Journal Article
Multicenter Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
853-868Subventions
Organisme : Celgene Corporation
Organisme : Merck
Organisme : Myeloma UK
Organisme : University of Leeds
Organisme : University of Birmingham
Organisme : Royal Marsden
Organisme : Institute of Cancer Research
Organisme : Cancer Research UK
ID : C1298/A10410
Pays : United Kingdom
Organisme : Cancer Research Institute
Pays : United States
Informations de copyright
© 2020 The Authors. British Journal of Haematology published by British Society for Haematology and John Wiley & Sons Ltd.
Références
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