Abstract
The effect of different maintenance therapies on outcome after autologous hematopoietic cell transplantation (AHCT) was analyzed in newly diagnosed multiple myeloma (NDMM) patients using global real-world data. NDMM patients transplanted between 2013 and 2017 were selected from the Worldwide Network for Blood and Marrow Transplantation (WBMT) registry. Overall survival (OS) was evaluated as primary and progression-free survival (PFS), non-relapse mortality and relapse/progression incidence as secondary endpoints. Multivariable 6- month landmark analyses were performed using Cox proportional hazards models including random effect for country.
Information was available on 8,269 patients with lenalidomide (n=4,148; 50.2%), thalidomide (n=689; 8.3%) or bortezomib (n=726; 8.8%) as maintenance or no maintenance (n=2,706; 32.7%). In the 6-month landmark analysis, OS at 3 years was higher after maintenance with lenalidomide (86%), with thalidomide (80%) and with bortezomib (83%) as compared to no maintenance (79%, p<0.001) irrespective of response status at AHCT. In multivariate analyses, maintenance with lenalidomide (HR0.57, 95%CI 0.48-0.68), thalidomide (HR0.76, 95%CI 0.58-1.00) and bortezomib (HR0.65, 95%CI 0.50-0.84) were associated with better OS compared to no maintenance. Compared to no maintenance, all three medications significantly improved PFS early after HCT. The effect was gone by 30, 6, and 12 months for lenalidomide, thalidomide, and bortezomib respectively. Maintenance with lenalidomide, and to a lesser extend thalidomide and bortezomib resulted in improved OS as compared to no-maintenance in all depths of response prior to AHCT. Weaker and shorter associations were observed for PFS reflecting maintenance type, therapy discontinuation and survivor effects.
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