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Consolidation with VTd significantly improves the complete remission rate and time to progression following VTd induction and single autologous stem cell transplantation in multiple myeloma

Leukemia volume 27, pages 2242–2244 (2013)Cite this article

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High-dose therapy plus autologous stem cell transplantation (ASCT) is considered the standard of care for the frontline treatment in younger patients with multiple myeloma (NDMM).1, 2, 3, 4 The achievement of complete response (CR) or at least very good partial response (VGPR) at the end of the ASCT procedure has been one of the key markers associated with an improved outcome.5, 6, 7 In recent years, several strategies were paralleled to increase the CR plus VGPR rate in the ASCT paradigm that included improving the induction treatment, and more recently, the consolidation and the maintenance phases post ASCT.3, 8 The high activity shown by immunomodulatory drugs and bortezomib-based regimens before ASCT has recently led to their use as consolidation and maintenance therapies. Several studies have demonstrated the impact of VTd on response rates and progression-free survival (PFS) either as induction or consolidation regimen in NDMM;9, 10, 11, 12, 13 however, no data are available regarding the role of VTd consolidation in the context of bortezomib-triple-based VTd induction regimen followed by a single ASCT.

We aimed to assess the efficacy and safety of VTd as consolidation therapy in the context of VTd as induction regimen, followed by a single ASCT (VTd-auto-VTd regimen). Thus, we have performed a retrospective multicentre study that has included NDMM eligible for ASCT upfront in two cohorts from 2009 to 2011 across nine IFM (Intergroupe Francophone du Myélome) centers. We recruited all patients diagnosed in the selected period of time in these centers in order to minimize the bias of our series. The VTd-auto-VTd cohort included 121 NDMM, a regimen consisting of three induction and two consolidation cycles of VTd (bortezomib 1.3 mg/m2 intravenously on days 1, 4, 8 and 11, thalidomide 100 mg/day orally and dexamethasone 40 mg weekly orally). All patients underwent ASCT with high-dose melphalan 200 mg/m2. The 96 NDMM of the second cohort (VTd-auto) completed the same VTd-auto regimen without consolidation. None of the patients received maintenance therapy across cohorts. The study was approved by the ethics committee of CHRU of Lille and was conducted in accordance with the principles of the Declaration of Helsinki. All response rates were determined according to the International Myeloma Working Group criteria.14

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Author notes

  1. X Leleu, G Fouquet and B Hebraud: These authors contributed equally to this work.

Authors and Affiliations

  1. Hôpital Huriez, CHRU, Lille, France

    X Leleu, G Fouquet & T Facon

  2. Hôpital Purpan, Toulouse, France

    B Hebraud, M Roussel, H A Loiseau & M Attal

  3. Hôpital d’Enfants, Dijon, France

    D Caillot & M L Chrétien

  4. Saint Louis, APHP, Paris, France

    B Arnulf, R Szalat & J P Fermand

  5. Saint Antoine, APHP, Paris, France

    L Garderet & L Benajiba

  6. Hôpital A Michallon, Grenoble, France

    B Pegourie & C Regny

  7. Hôpital Sud, Amiens, France

    B Royer & A Caulier

  8. Institut Paoli Calmettes, Marseille, France

    A M Stoppa & S Garciaz

  9. Hotel Dieu, Nantes, France

    C Touzeau & P Moreau

  10. Hôpital Gabriel-Montpied, Clermont-Ferrand, France

    C Chaleteix

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on behalf of Intergroupe Francophone du Myélome (IFM)

Corresponding author

Correspondence to P Moreau.

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Competing interests

XL, MR, MA, TF, PM, HAL and CH disclose lecture fees from Celgene and Janssen; XL discloses research support from Celgene and Janssen. The remaining authors declare no conflict of interest.

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Author contributions

Conception and design: XL, PM, MA. Collection and assembly of data: XL, MA, PM, GF, BH, MR, DC, MLC, CC, BA, RS, LG, LB, BP, CR, BR, AC, MS, SG, CT, JPF, HAL, TF. Cytogenetic data: HAL. Data analysis and interpretation: XL, PM. Manuscript writing: XL, PM.

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Leleu, X., Fouquet, G., Hebraud, B. et al. Consolidation with VTd significantly improves the complete remission rate and time to progression following VTd induction and single autologous stem cell transplantation in multiple myeloma. Leukemia 27, 2242–2244 (2013). https://doi.org/10.1038/leu.2013.101

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