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Sequential Bortezomib, Dexamethasone, and Thalidomide Maintenance Therapy after Single Autologous Peripheral Stem Cell Transplantation in Patients with Multiple Myeloma

2011; Elsevier BV; Volume: 18; Issue: 3 Linguagem: Inglês

10.1016/j.bbmt.2011.12.580

1523-6536

Firoozeh Sahebi, Paul Frankel, Len Farol, Amrita Krishnan, Ji‐Lian Cai, George Somlo, Sandra H. Thomas, Eunicia Reburiano, Leslie Popplewell, Pablo Parker, Ricardo Spielberger, Neil Kogut, Chatchada Karanes, Myo Htut, Christopher Ruel, Lupe Duarte, Joyce Murata‐Collins, Stephen J. Forman,

Protein Degradation and Inhibitors

We report feasibility and response results of a phase II study investigating prolonged weekly bortezomib and dexamethasone followed by thalidomide and dexamethasone as maintenance therapy after single autologous stem cell transplantation (ASCT) in patients with multiple myeloma. Within 4 to 8 weeks of ASCT, patients received weekly bortezomib and dexamethasone for six cycles, followed by thalidomide and dexamethasone for six more cycles. Thalidomide alone was continued until disease progression. Forty-five patients underwent ASCT. Forty patients started maintenance therapy; of these, 36 patients received four cycles, and 32 completed six cycles of maintenance bortezomib. Of these 40 patients, nine (22%) were in complete response (CR) before ASCT, 13 (32%) achieved CR after ASCT but before bortezomib maintenance therapy, and 21 (53%) achieved CR after bortezomib maintenance therapy. Nine patients not previously in CR (33%) upgraded their response to CR with bortezomib maintenance. At 1 year post-ASCT, 20 patients achieved CR, and two achieved very good partial response. Twenty-seven patients experienced peripheral neuropathy during bortezomib therapy, all grade 1 or 2. Our findings indicate that prolonged sequential weekly bortezomib, dexamethasone, and thalidomide maintenance therapy after single ASCT is feasible and well tolerated. Bortezomib maintenance treatment upgraded post-ASCT CR responses with no severe grade 3/4 peripheral neuropathy.