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Novel agents have a significant impact on survival of patients with multiple myeloma

Neue Substanzen führen zu einer signifikanten Verlängerung des Gesamtüberlebens bei Patienten mit Multiplem Myelom

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Summary

Background

In addition to conventional chemotherapeutic regimens and autologous transplantation, novel agents are now part of the treatment armamentarium against multiple myeloma (MM). To evaluate the presumed benefit of novel agents, we performed an analysis of patients with MM at our institution before and after the availability of novel agents.

Design and methods

In all, 200 consecutive patients with newly diagnosed MM (male = 119; female = 81; median age: 61.5 years) treated at our institution between June 1993 and December 2008 were included in this retrospective analysis. Patient cohorts were defined according to date of diagnosis (before and after 01-Jan-2000, respectively), treatment received (chemotherapy only vs. therapy including novel agents), risk profile (International Staging System (ISS)-stage), and cytogenetic features. Primary focus of the analysis was overall survival (OS).

Results

Median OS for MM patients who received conventional chemotherapy was 45.2 months and for patients who received novel agents 74.6 months (P < 0.01). OS for those patients who relapsed after autotransplantation before 2000 was 35.2 months, but 72.7 months (P < 0.01) for those patients with a later relapse. Prolongation of survival for patients receiving novel agents was most evident for patients with ISS stage III (median OS 68.4 vs. 11.2 months for patients with chemotherapy only; P < 0.01). MM patients with an intermediate risk had a longer median OS when receiving novel agents (47.2 vs. 32.8 months).

Conclusion

Treatment with novel agents in MM resulted in a significant prolongation of OS. Benefit of therapy with novel agents was particularly evident for transplant-eligible patients and MM patients with unfavorable prognosis.

Zusammenfassung

Hintergrund

Zusätzlich zur konventionellen Chemotherapie und der autologen Stammzelltransplantation gehören die sog. neuen Substanzen (Thalidomid, Bortezomib, Lenalidomid) nun zur Standardtherapie in der Behandlung des Multiplen Myeloms (MM). Um den Nutzen gegenüber der alleinigen Chemotherapie zu untersuchen, haben wir die Patienten mit Multiplen Myelom an unserer Institution vor und seit der Einführung der neuen Substanzen evaluiert.

Design und Methoden

200 Patienten mit neudiagnostiziertem MM im Zeitraum zwischen Juni 1993 und Dezember 2008 (119 Männer; 81 Frauen; medianes Alter: 61,5 Jahre) wurden in diese retrospektive Analyse eingeschlossen. Patientenkohorten wurden anhand des Zeitpunkts der Erstdiagnose (vor und nach dem 1. Jänner 2000), der Therapie (alleinige Chemotherapie gegenüber Therapie einschließlich der neuen Substanzen), des Risikoprofils (ISS Stadium) und zytogenetischer Faktoren definiert. Primäres Ziel der Analyse war das Gesamtüberleben.

Ergebnisse

Das mediane Gesamtüberleben für Patienten unter konventioneller Chemotherapie betrug 45,2 Monate gegenüber 74,6 Monate bei Behandlung inklusive neuer Substanzen (p < 0,01). Das Gesamtüberleben für Patienten mit Rezidiv nach autologer Transplantation war ebenfalls signifikant unterschiedlich (median 35,2 Monate vs. 72,7 Monate bei Rezidiv vor bzw. nach dem Jahr 2000; p < 0,01). Eine Verlängerung des Gesamtüberlebens unter neuen Substanzen war vor allem für Patienten mit hohem Risikoprofil (ISS Stadium III; 68,4 gegenüber 11,2 Monate; p < 0,01) zu beobachten. Auch Patienten mit einem intermediären Risikoprofil hatten ein längeres Gesamtüberleben mit den neuen Substanzen (47,2 gegenüber 32,8 Monate).

Schlussfolgerung

Behandlung mit neuen Substanzen resultiert in einem verlängerten Gesamtüberleben beim MM. Der Nutzen zeigte sich insbesondere bei Patienten im Rezidiv nach autologer Stammzellentransplantation sowie Patienten mit ungünstigem Risikoprofil.

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Authors and Affiliations

  1. Department of Medicine I, Clinical Division of Oncology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria

    Wolfgang Lamm, Sandra Eder, Christoph C. Zielinski & Johannes Drach MD

  2. Department of Medicine I, Bone Marrow Transplant Unit, Medical University of Vienna, Vienna, Austria

    Marija Bojic

Authors
  1. Wolfgang Lamm
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  2. Sandra Eder
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  3. Marija Bojic
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  4. Christoph C. Zielinski
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  5. Johannes Drach MD
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Correspondence to Johannes Drach MD.

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Lamm, W., Eder, S., Bojic, M. et al. Novel agents have a significant impact on survival of patients with multiple myeloma. Wien Klin Wochenschr 127, 92–97 (2015). https://doi.org/10.1007/s00508-014-0605-6

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  • DOI: https://doi.org/10.1007/s00508-014-0605-6

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