Rapidity and quality of response to steroid-based induction therapy, without the addition of novel agents, does not affect post transplant outcomes in multiple myeloma

Abstract

Background: The goal of induction in younger MM patients is to improve performance status and symptoms, enabling autologous stem cell transplantation (ASCT). It is unclear whether intensification of induction regimens improves post transplant outcomes.

Patients and methods: We studied 178 MM patients who received conservative steroid-based induction therapy without novel agents before ASCT between 2000 and 2006 and correlated induction parameters (rapidity of response, need for salvage induction therapy, depth of response) with transplant outcomes.

Results: Fifty-three percent of patients achieved at least a partial response by cycle 2 (early responders). Rapidity of induction response did not translate into a significant difference in post transplant progression-free survival (PFS) (20.7 vs. 20.0 months; P = .24) or overall survival (OS) (64.4 vs. 51.3 months, respectively; P = .13). In 41 patients (23%) the first induction regimen failed, but they responded to salvage and proceeded to ASCT. They had inferior PFS (15.6 vs. 21.8 months; P = .008) and OS (43.5 vs. 69.4 months; P = .0004) post transplant compared with those requiring 1 regimen.

Conclusion: Rapid response to induction therapy does not correlate with PFS or OS post ASCT when using a conservative steroid-based induction regimen. Patients in whom this initial induction fails have worse post transplant outcomes, thus the upfront use of intensive therapies with novel agents should be considered.