Cited by 1,257Multiple Myeloma Research and TreatmentsBone health and treatmentsAmyloidosis: Diagnosis, Treatment, Outcomes

Lenalidomide, Bortezomib, and Dexamethasone with Transplantation for Myeloma

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Attal, Michel, Lauwers-Cances, Valerie, Hulin, Cyrille, Leleu, Xavier, Caillot, Denis, Escoffre, Martine, Arnulf, Bertrand, Macro, Margaret +18 more·2017·New England Journal of Medicine

Abstract

BACKGROUND: High-dose chemotherapy plus autologous stem-cell transplantation has been the standard treatment for newly diagnosed multiple myeloma in adults up to 65 years of age. However, promising data on the use of combination therapy with lenalidomide, bortezomib, and dexamethasone (RVD) in this population have raised questions about the role and timing of transplantation. METHODS: We randomly assigned 700 patients with multiple myeloma to receive induction therapy with three cycles of RVD and then consolidation therapy with either five additional cycles of RVD (350 patients) or high-dose melphalan plus stem-cell transplantation followed by two additional cycles of RVD (350 patients). Patients in both groups received maintenance therapy with lenalidomide for 1 year. The primary end point was progression-free survival. RESULTS: Median progression-free survival was significantly longer in the group that underwent transplantation than in the group that received RVD alone (50 months vs. 36 months; adjusted hazard ratio for disease progression or death, 0.65; P<0.001). This benefit was observed across all patient subgroups, including those stratified according to International Staging System stage and cytogenetic risk. The percentage of patients with a complete response was higher in the transplantation group than in the RVD-alone group (59% vs. 48%, P=0.03), as was the percentage of patients in whom minimal residual disease was not detected (79% vs. 65%, P<0.001). Overall survival at 4 years did not differ significantly between the transplantation group and the RVD-alone group (81% and 82%, respectively). The rate of grade 3 or 4 neutropenia was significantly higher in the transplantation group than in the RVD-alone group (92% vs. 47%), as were the rates of grade 3 or 4 gastrointestinal disorders (28% vs. 7%) and infections (20% vs. 9%). No significant between-group differences were observed in the rates of treatment-related deaths, second primary cancers, thromboembolic events, and peripheral neuropathy. CONCLUSIONS: Among adults with multiple myeloma, RVD therapy plus transplantation was associated with significantly longer progression-free survival than RVD therapy alone, but overall survival did not differ significantly between the two approaches. (Supported by Celgene and others; IFM 2009 Study ClinicalTrials.gov number, NCT01191060 .).

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  • Randomized trials have consistently found similar overall survival with early ASCT versus delayed ASCT.

    “However, randomized trials have consistently found similar OS with early ASCT (immediately following 4 cycles of induction therapy) versus delayed ASCT (at the time of relapse as salvage therapy).94,129–131”

    From Multiple myeloma: 2024 update on diagnosis, risk-stratification, and management (2024) · cites this paper as [94]

    The Results report similar four-year overall survival with early transplantation and RVD alone, and the Discussion says several earlier randomized trials found no significant overall-survival difference when salvage transplantation was allowed. But the Discussion also reports two studies finding an overall-survival benefit with first-line transplantation, so “consistently” overstates the evidence. This trial used three induction cycles, not four; neither passage provides a page number. (LLM, conf=0.87)

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  1. [21]21. Richardson PG, Weller E, Lonial S, et al. Lenalidomide, bortezomib, and dexa- methasone combination therapy in pa- tients with newly diagnosed multiple my- eloma. Blood 2010; 116: 679-86.

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Authors
Attal, M., Lauwers-Cances, V., Hulin, C., Leleu, X., Caillot, D., Escoffre, M., Arnulf, B., Macro, M., Belhadj, K., Garderet, L., Roussel, M., Payen, C., Mathiot, C., Fermand, J. P., Meuleman, N., Rollet, S., Maglio, M. E., Zeytoonjian, A. A., Weller, E. A., Munshi, N., Anderson, K. C., Richardson, P. G., Facon, T., Avet-Loiseau, H., Harousseau, J.-L., & Moreau, P.
Affiliations
  • Centre Hospitalier Universitaire de Toulouse (FR)
  • Institut Jules Bordet (BE)
Venue
New England Journal of Medicine
Published
2017-04-06
Volume
376
Issue
14
Pages
1311-1320
ISSN
  • 0028-4793 (ISSN-L)
  • 1533-4406
OpenAlex
W2604776612
Cited by
1,257
References
41
Citations by year
2026: 80 · 2025: 119 · 2024: 116 · 2023: 145 · 2022: 138 · 2021: 174 · 2020: 191 · 2019: 119 · 2018: 110 · 2017: 58 · 2013: 1 · 2012: 1
FWCI
100.39
Type
journal article
Language
en
Open access
Locations
  • New England Journal of Medicine (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
  • HAL (submittedVersion)
  • Dépôt institutionnel de l'Université libre de Bruxelles (Université Libre de Bruxelles) (submittedVersion)
Funders
  • Amgen
  • Bristol-Myers Squibb
  • Sanofi
  • Gilead Sciences
  • Celgene
  • Agence Nationale de la Recherche (ANR-11-PHUC-0001)
  • National Cancer Institute (P01CA155258)
Topics
  • Health Sciences › Medicine › Hematology › Multiple Myeloma Research and Treatments
  • Health Sciences › Medicine › Oncology › Bone health and treatments
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Amyloidosis: Diagnosis, Treatment, Outcomes
Keywords
multiple myeloma, lenalidomide, bortezomib, dexamethasone, autologous stem cell transplantation, high-dose melphalan, progression-free survival, complete response, minimal residual disease, neutropenia, elderly patients, newly diagnosed multiple myeloma, consolidation therapy, maintenance therapy, overall survival, treatment toxicity, secondary malignancies
MeSH terms
Bortezomib, Lenalidomide, Adult, Aged, Antineoplastic Combined Chemotherapy Protocols, Combined Modality Therapy, Dexamethasone, Female, Humans, Male, Middle Aged, Multiple Myeloma, Thalidomide, Transplantation, Autologous, Salvage Therapy, Disease-Free Survival, Stem Cell Transplantation, Kaplan-Meier Estimate, Maintenance Chemotherapy, Induction Chemotherapy

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