scholarly journals GM-CSF and interferon-α maintenance therapy for multiple myeloma patients after autologous stem cell transplantation (ASCT): An interim report

2005 ◽  
Vol 11 (2) ◽  
pp. 75-76
Author(s):  
S. Gowda ◽  
C.R. Cogle ◽  
S.A. Khan ◽  
J.S. Moreb
Keyword(s):  
Multiple Myeloma ◽  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Maintenance Therapy ◽  
Cell Transplantation ◽  
Autologous Stem Cell Transplantation ◽  
Interferon Α ◽  
Interim Report ◽  
Gm Csf

scholarly journals Combination of IFN-α/Gm-CSF as a Maintenance Therapy for Multiple Myeloma Patients after Autologous Stem Cell Transplantation (ASCT): A Prospective Phase II Study

2010 ◽  
Vol 4 ◽  
pp. CMO.S6161 ◽  
Author(s):  
Donya Salmasinia ◽  
Myron Chang ◽  
John R. Wingard ◽  
Wei Hou ◽  
Jan S. Moreb
Keyword(s):  
Multiple Myeloma ◽  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Maintenance Therapy ◽  
Cell Transplantation ◽  
Autologous Stem Cell Transplantation ◽  
Progression Free Survival ◽  
Gm Csf ◽  
Prospective Phase

Interferon alpha (IFN-α) has been used as a maintenance therapy after autologous stem cell transplantation (ASCT) for multiple myeloma (MM) patients. In this study, we combined GM-CSF with IFN-α in order to improve IFN tolerance in post-ASCT myeloma patients. Primary aims were to evaluate myelotoxicity and effectiveness of this maintenance therapy. The treatment included 4 × 10 6 units of IFN-α and 125 μg/m2 of GM-CSF given three times a week for twelve months. Twenty seven patients were enrolled within 120 days after ASCT. One patient discontinued treatment due to thrombocytopenia and seven others were taken off study due to fu-like symptoms and/or increase in liver enzymes. With a median follow-up of 45.5 months, the median overall survival was not reached while the median progression-free survival was 28 months. Eleven patients (42%) have remained in very good partial remission or complete remission since ASCT. In conclusion, our results demonstrate that maintenance with GM-CSF and IFN-α is safe and effective.

The evolving role of maintenance therapy following autologous stem cell transplantation in multiple myeloma

2019 ◽  
Vol 19 (10) ◽  
pp. 889-898 ◽  
Author(s):  
Almuth Maria Anni Merz ◽  
Maximilian Merz ◽  
Jens Hillengass ◽  
Sarah A. Holstein ◽  
Philip McCarthy
Keyword(s):  
Multiple Myeloma ◽  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Maintenance Therapy ◽  
Cell Transplantation ◽  
Autologous Stem Cell Transplantation

scholarly journals Outcomes of Maintenance Therapy with Bortezomib after Autologous Stem Cell Transplantation for Patients with Multiple Myeloma

2017 ◽  
Vol 23 (2) ◽  
pp. 262-268 ◽  
Author(s):  
Dharshan Sivaraj ◽  
Michael M. Green ◽  
Zhiguo Li ◽  
Anthony D. Sung ◽  
Stefanie Sarantopoulos ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Maintenance Therapy ◽  
Cell Transplantation ◽  
Autologous Stem Cell Transplantation

scholarly journals IMWG consensus on maintenance therapy in multiple myeloma

Blood ◽  
2012 ◽  
Vol 119 (13) ◽  
pp. 3003-3015 ◽  
Author(s):  
Heinz Ludwig ◽  
Brian G. M. Durie ◽  
Philip McCarthy ◽  
Antonio Palumbo ◽  
Jésus San Miguel ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Maintenance Therapy ◽  
Risk Reduction ◽  
Cell Transplantation ◽  
Autologous Stem Cell Transplantation ◽  
Maintenance Treatment ◽  
Significant Risk ◽  
Free Survival

Abstract Maintaining results of successful induction therapy is an important goal in multiple myeloma. Here, members of the International Myeloma Working Group review the relevant data. Thalidomide maintenance therapy after autologous stem cell transplantation improved the quality of response and increased progression-free survival (PFS) significantly in all 6 studies and overall survival (OS) in 3 of them. In elderly patients, 2 trials showed a significant prolongation of PFS, but no improvement in OS. A meta-analysis revealed a significant risk reduction for PFS/event-free survival and death. The role of thalidomide maintenance after melphalan, prednisone, and thalidomide is not well established. Two trials with lenalidomide maintenance treatment after autologous stem cell transplantation and one study after conventional melphalan, prednisone, and lenalidomide induction therapy showed a significant risk reduction for PFS and an increase in OS in one of the transplant trials. Maintenance therapy with single-agent bortezomib or in combination with thalidomide or prednisone has been studied. One trial revealed a significantly increased OS with a bortezomib-based induction and bortezomib maintenance therapy compared with conventional induction and thalidomide maintenance treatment. Maintenance treatment can be associated with significant side effects, and none of the drugs evaluated is approved for maintenance therapy. Treatment decisions for individual patients must balance potential benefits and risks carefully, as a widely agreed-on standard is not established.

Cyclophosphamide Maintenance Therapy Is a Safe and Effective Alternative In Multiple Myeloma Patients Who Undergo Autologous Stem Cell Transplantation

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 5373-5373
Author(s):  
Michael T. Byrne ◽  
Jan S Moreb
Keyword(s):  
Multiple Myeloma ◽  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Maintenance Therapy ◽  
Cell Transplantation ◽  
Median Time ◽  
Autologous Stem Cell Transplantation ◽  
Comparable Efficacy ◽  
Secondary Malignancies ◽  
Remission Maintenance

Background In spite of recent improvements in survival, multiple myeloma (MM) remains an incurable disease.  Following autologous stem cell transplantation (ASCT), maintenance therapy has been shown to improve progression free survival (PFS) but data on overall survival (OS) is mixed.  The expense of therapy is significant and a substantial number of patients are unable to tolerate its toxicity.  In this study, we report our experience with the use of oral cyclophosphamide ± prednisone (CY) as an alternative for these patients.  Methods From January of 2000 to December of 2010, we retrospectively evaluated all patients with MM who underwent ASCT at our institution and separated them into four groups depending on maintenance therapy: No maintenance, interferon ± prednisone (IFN/Pd), IMIDs, and CY.  Patients who received maintenance after their first relapse were analyzed separately for tolerability, PFS, and OS.  Survival data was analyzed by logrank test and the group characteristics were compared using an unpaired t-test.    Results A total of 288 patients underwent ASCT at our institution from 2000 to 2010.  Of these patients, 8 were excluded due to insufficient follow-up.  1 patient who received bortezomib was also excluded. The median age at diagnosis was 58.0 years and the median time from diagnosis to ASCT was 8.3 months.  Collectively, this cohort included 193 Caucasians, 64 African Americans, 16 Hispanics, 4 Asian and 2 unknown race; 55.7% were men and 44.3% were women.  Following ASCT, 112 patients received no maintenance therapy, 74 of them (66.1%) had documented relapses with a median PFS of 18.2 months.  78 patients received IFN/Pd; 55 of them (70.5%) relapsed with a median PFS of 18.4 months. Alternatively, 79 patients were treated with IMIDs with 40 known relapses (50.6%) and a median PFS of 22.5 months.   CY maintenance was used in 10 patients; six patients relapsed within a median time of 20.4 months.  Collectively, maintenance therapy was associated with a significant improvement in PFS (22.5 vs. 18.2 months, p=0.037) but no difference in OS (45.5 vs. 43.9 months, p=0.29).  Among patients treated with maintenance therapy, PFS was superior in the group treated with IMIDs compared to IFN/Pd (22.5 vs. 18.4 months, p <0.001) however there was no improvement in OS (43.1 vs. 46.5 months, p=0.29). PFS was equivocal between CY and all other maintenance (20.4 vs. 22.5 months, p=0.19).  OS of first-remission CY vs. other maintenance therapy cannot be calculated due to small sample size.  34.6-38.8% of patients who received non-CY maintenance therapy had toxicity requiring dose reductions or discontinuation whereas 10% of CY patients developed toxicity (Table 1).  Following relapse and salvage therapy, 78 patients received non-CY second-remission maintenance therapy with a median PFS of 9.2 months whereas those treated with second-remission CY (n=25) had a median PFS of 11.7 months (p=0.89).  OS was comparable between the two groups (69.2 vs. 79.8 months, p=0.44).  Patients who received CY, however, had a significantly longer OS compared to those who did not receive second-remission maintenance therapy (79.8 vs. 41.2 months, p<0.001) and a trend toward improved OS compared to other forms of second remission maintenance (p=0.085).  5.0% of patients in this study developed secondary malignancies: 4 in non-maintenance group, 3 in the IFN/Pd group, 6 in the IMID group, and 1 in the CY group (Table 2).  Conclusions  CY is well tolerated with comparable efficacy to other maintenance drugs in MM, particularly in the second maintenance setting. Our data corroborates published experience that maintenance therapy improves PFS but often fails to impact OS.  Such improvement in PFS with conventional maintenance therapy is associated with a high rate of toxicity and an increase in secondary malignancies. Disclosures: No relevant conflicts of interest to declare.

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