Dose-dense and less dose-intense Total Therapy 5 for gene expression profiling-defined high-risk multiple myeloma.

Abstract

Multiple myeloma (MM) is a heterogeneous disease with high-risk patients progressing rapidly despite treatment. Various definitions of high-risk MM are used and we reported that gene expression profile (GEP)-defined high risk was a major predictor of relapse. In spite of our best efforts, the majority of GEP70 high-risk patients relapse and we have noted higher relapse rates during drug-free intervals. This prompted us to explore the concept of less intense drug dosing with shorter intervals between courses with the aim of preventing inter-course relapse. Here we report the outcome of the Total Therapy 5 trial, where this concept was tested. This regimen effectively reduced early mortality and relapse but failed to improve progression-free survival and overall survival due to relapse early during maintenance.

• Authors: Y Jethava, A Mitchell, M Zangari, S Waheed, C Schinke, S Thanendrarajan, J Sawyer, D Alapat, E Tian, C Stein, R Khan, C J Heuck, N Petty, D Avery, D Steward, R Smith, C Bailey, J Epstein, S Yaccoby, A Hoering, J Crowley, G Morgan, B Barlogie, F van Rhee
• Journal: Blood cancer journal (Blood Cancer J) Vol. 6 Issue 7 Pg. e453 (07 29 2016) ISSN: 2044-5385 [Electronic] United States
• PMID: 27471869 (Publication Type: Clinical Trial, Journal Article)

Chemical References

• Neoplasm Proteins
• Thalidomide
• Bortezomib
• Lenalidomide
• Melphalan

Topics

• Adult
• Aged
• Antineoplastic Combined Chemotherapy Protocols (administration & dosage)
• Bortezomib (administration & dosage)
• Disease-Free Survival
• Dose-Response Relationship, Drug
• Female
• Gene Expression Profiling (methods)
• Gene Expression Regulation, Neoplastic (drug effects)
• Humans
• Lenalidomide
• Male
• Melphalan (administration & dosage)
• Middle Aged
• Multiple Myeloma (drug therapy, genetics, pathology)
• Neoplasm Proteins (biosynthesis, genetics)
• Thalidomide (administration & dosage, analogs & derivatives)