IFM 2009: lenalidomide, bortezomib and dexamethasone with or without upfront transplantation for myeloma
Adding an early autologous stem cell transplant to modern three-drug therapy delayed relapse in newly diagnosed myeloma, though overall survival was similar because patients in the drug-only arm could have a transplant later.
Overview
Phase 3 trial of 700 adults up to 65 with newly diagnosed multiple myeloma randomised to lenalidomide, bortezomib and dexamethasone (RVD) alone (eight cycles) or RVD with high-dose melphalan and autologous transplant, both followed by a year of lenalidomide maintenance.
Median progression-free survival was 50 months with transplant against 36 months without; complete response 59 versus 48 percent. Four-year overall survival was 81 versus 82 percent, with most drug-only patients receiving transplant at relapse.
- Median progression-free survival 50 vs 36 months (hazard ratio 0.65).
- Complete response 59 percent vs 48 percent; no overall survival difference at four years.
Upfront transplant remains standard for fit patients because it lengthens the first remission, but deferring it to first relapse is a reasonable choice for some, particularly with deeper modern induction.
- Lenalidomide maintenance was limited to one year, shorter than current practice.
- Quadruplet induction with daratumumab was not used.
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