In a nutshell
This study investigated the use of bortezomib (BTZ; Velcade) maintenance after allogeneic hematopoietic cell transplant (alloHCT) for improving relapse and chronic graft versus host disease (cGVHD) in patients with multiple myeloma (MM) that are young or high-risk. The data showed that BTZ maintenance is effective and safe in these patients.
MM is an incurable type of blood cancer. Despite new treatment approaches, young patients or those that are at high-risk may not benefit from prolonged survival or remission.
AlloHCT has been reported to increase long-term survival in patients. It involves replacing a patient’s cancer cells that have been removed with strong chemotherapy with healthy donor cells by transplantation. However, cGVHD (occurs when transplanted donor cells regard the patient’s body as foreign and launch an attack) remains a possible complication with alloHCT.
Concerns exist over the use of alloHCT in patients with newly diagnosed MM (NDMM), primarily related to NRM (death without recurrent or progressive disease), cGVHD, and relapse (return of cancer after treatment). It remains unclear whether BTZ can improve survival and cGVHD after alloHCT when given as maintenance therapy in young or high-risk patients with MM.
Methods & findings
This study involved 39 young and high-risk patients with NDMM. Patients received both auto-alloHCT (stem cells from a donor and from the patients given at the same time), followed by subcutaneous (under the skin injection) BTZ, given every 2 weeks. Patients were followed up for an average of 48 months.
The average survival without cancer worsening was 49 months. At 2 years, 69% of patients were alive without cancer worsening and 92% of patients were alive. After 5 years, 80% of patients were alive. After 2 years, 26% of patients had cancer worsening and after 5 years, 48% of patients had cancer worsening.
After 1 year, 26% of patients had mild to moderate short-term GVHD, and 13% had severe GVHD. At 2 years, there was an overall 57% occurrence of long-term GVHD.
The bottom line
The study suggested that BTZ maintenance therapy may be useful after alloHCT in young or high-risk patients with NDMM.
The fine print
The study had a small number of participants. Also, there was no comparison group. Further studies are needed.
Published By :
Bone Marrow Transplantation
Nov 29, 2021
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