1 / 8

Vincent Rajkumar, MD

Vincent Rajkumar, MD. Mayo Clinic Rochester, MN. Induction Therapy: Thal/Dex in Newly Diagnosed MM. Mayo Clinic Study: 50 Patients 64% response rate MDACC Study: 40 Patients 72% response rate ECOG: Thal/Dex vs Dex: 58% vs 42%.

aloha
Télécharger la présentation

Vincent Rajkumar, MD

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Vincent Rajkumar, MD Mayo Clinic Rochester, MN

  2. Induction Therapy: Thal/Dex in Newly Diagnosed MM • Mayo Clinic Study: 50 Patients64% response rate • MDACC Study: 40 Patients72% response rate • ECOG: Thal/Dex vs Dex: 58% vs 42% Rajkumar SV. J Clin Oncol. 2002; 20:4319-4323Weber D. J Clin Oncol. 2003; 21:16-19Rajkumar SV. ASH 2004; Abstract 205

  3. Results with Stem Cell Transplantation 1.00 100 p=0.03 by Wilcoxon test p=0.04 by log-rank test Highdose 0.75 54 75 Intensivetherapy 42 0.50 50 Overall survival (%) Survival Standard therapy Conventional dose 0.25 25 0.00 0 0 20 40 60 80 0 15 30 45 60 Month Month Attal M. N Engl J Med. 1996; 335:97 Child J. N Engl J Med. 2003; 348:1875

  4. Early vs. Delayed Transplant Auto BMT (n=258) – 58 months VBMCP (n=252) – 53 months Allo (n=42) – 13 months 1.0 Early HDT Late HDT 100 0.9 0.8 80 0.7 0.6 60 P (survival) 0.5 % 0.4 40 0.3 0.2 20 0.1 0.0 0 0 10 20 30 40 50 60 70 80 90 100 0 24 48 72 96 120 Months Months Fermand. Blood. 1998; 92:3131 Barlogie B. ASH 2003; Abstract 135

  5. Advantages of Early Transplant • Better quality of life • Evaluation of tandem transplant • Evaluation of trials investigating maintenance therapy • Insurance issues

  6. High-Risk MM • Deletion 13 or hypodiploidy • PCLI >3% • Molecular Genetics: t(4;14), t(14;16), 17p- Rajkumar SV. Best Pract Res Clin Haem. 2005;18:585-601

  7. 0 12 24 36 48 60 72 84 96 108 120 1.0 0.9 0.8 0.7 0.6 0.5 0.4 0.3 0.2 0.1 0.0 Presence of Hypodiploidy or Deletion 13 and Survival Risk group Median OS Normal (n=984) 51 monthsOther Abn. Karyotypes (n=236) 36 monthsHypodiploidy/del 13 (n=255) 19 months Probability of Event-Free Survival P<0.001 Months From First Transplant Fassas A. Br J Haem. 2002; 118:1041-1047

  8. Approach to Newly Diagnosed Myeloma Low Risk High Risk Not a Transplant Candidate Transplant Candidate • Novel Rx • Novel Agents • Auto-Mini-Allo • Routine Maintenance MP or MPT or MPR/MPV/ Rev-Dex on trial Rev-Dex on trial or Dex or Thal-Dex x 4 Stem Cell Harvest for 2 Transplants Tx1; Tx2 for pts not in CR/VGPR Continue induction at lower dosesorConventional chemo; Tx at relapse Rajkumar SV. Mayo Clin Proc. 2005; 80:1371-1382

More Related