Researchers from the University of Arkansas have reported a 10% continuous complete remission rate for patients with newly diagnosed multiple myeloma (MM) who are treated with chemotherapy induction, tandem autotransplants, and interferon maintenance. These researchers also suggest that continued improvements in a “total therapy” (TT) approach should increase this 10% “cure” rate. The details of this study were presented at the 2008 meeting of the American Society of Clinical Oncology in Chicago, May 30-June 2.¹

Autologous stem cell transplants are an integral part of treatment of younger, fit patients with MM and have undoubtedly improved survival. The current consensus is that a second or tandem autologous transplant is of benefit in patients who are not in complete remission following the first transplant. The development of Thalomid® (thalidomide), Velcade® (bortezomib), and Revlimid® (lenalidomide) has also been an important contribution to the improved outcomes of patients with MM. Researchers at the University of Arkansas have performed a series of Phase II studies evaluating a TT approach. At present they have published data on three consecutive TT studies. TT1 evaluated an induction therapy with VAD (vincristine, doxorubicin, and dexamethasone), followed by tandem high-dose melphalan treatments and supported by autologous peripheral blood stem cells, which was followed by interferon maintenance. TT2 was a study evaluating the addition of Thalomid, while TT3 evaluated the addition of Thalomid and Velcade. The following table summarizes the main findings in these three consecutive trials:

These researchers also reported that Velcade appeared to overcome the adverse effects of t (4;14) and TP53 deletion. It was concluded that there was an apparent plateau of 10% continuous CR at 10 years, which may be a possible sign of cure.

Comments: There is the possibility that the fraction of patients remaining in continuous CR at 10 years will increase with further follow-up of TT2 and TT3. These data are consistent with other reports showing an improved survival of patients with MM over the past two decades.

Related News:

Velcade® (Bortezomib) Induction Improves Outcomes of Patients with Myeloma Receiving Stem Cell Transplants (1/15/2008)

Double Autografts Improve Progression-Free Survival in Patients with Myeloma (6/26/2007)

Allogeneic Superior to Autologous Stem Cell Transplants for Multiple Myeloma (3/16/2007)

Thalomid® Not Associated with Survival Improvement in Multiple Myeloma (3/13/2006)

Post-Transplant Thalidomide and Pamidronate of Benefit in Myeloma (5/11/2005)

Tandem Autologous Stem Cell Transplants Improve Survival of Patients with Multiple Myeloma (12/29/2003)

Reference:

¹ Barlogie B, Anaissie EJ, van Rhee F, et al. Total Therapy (TT) for myeloma (MM—10% cure rate with TT1 sugested by .10 year complete remission (CCR)L Bortezomib in TT3 overcomes poor-risk associated with T(4;14) and CelTP53 in TT2. Journal of Clinical Oncology. 2008;26; abstract 8516.