J Cancer 2014; 5(3):248-252. doi:10.7150/jca.8541 This issue

Research Paper

Partial Response at Completion of Bortezomib-Thalidomide-Dexamethasone (VTd) Induction Regimen Upfront in Multiple Myeloma Does Not Preclude Response to VTd in Consolidation

Guillemette Fouquet1, Benjamin Hebraud2, Sylvain Garciaz3, Anne Marie Stoppa3, Murielle Roussel2, Denis Caillot4, Marie Lorraine Chrétien4, Bertrand Arnulf5, Raphael Szalat5, Laurent Garderet6, Lina Benajiba6, Brigitte Pegourie7, Caroline Regny7, Bruno Royer8, Alexis Caulier8, Cyrille Touzeau9, Benoit Tessoulin9, Jean Paul Fermand5, Thierry Facon1, Michel Attal2, Hervé Avet Loiseau2, Philippe Moreau9, Xavier Leleu1✉

1. Hôpital Huriez, CHRU, Lille, France;
2. Hôpital Purpan, Toulouse, France;
3. Institut Paoli Calmettes, Marseille, France;
4. Hôpital d'Enfants, Dijon, France;
5. Saint Louis, APHP, Paris, France;
6. Saint Antoine, APHP, Paris, France;
7. Hôpital A. Michallon, Grenoble, France;
8. Hôpital Sud, Amiens, France;
9. Hotel Dieu, Nantes, France.
On behalf of Intergroupe Francophone du Myélome (IFM). GF, BH and SG co first author. PM and XL co senior authors.

This is an open access article distributed under the terms of the Creative Commons Attribution (CC BY-NC) License. See http://ivyspring.com/terms for full terms and conditions.
Fouquet G, Hebraud B, Garciaz S, Stoppa AM, Roussel M, Caillot D, Chrétien ML, Arnulf B, Szalat R, Garderet L, Benajiba L, Pegourie B, Regny C, Royer B, Caulier A, Touzeau C, Tessoulin B, Fermand JP, Facon T, Attal M, Loiseau HA, Moreau P, Leleu X. Partial Response at Completion of Bortezomib-Thalidomide-Dexamethasone (VTd) Induction Regimen Upfront in Multiple Myeloma Does Not Preclude Response to VTd in Consolidation. J Cancer 2014; 5(3):248-252. doi:10.7150/jca.8541. Available from https://www.jcancer.org/v05p0248.htm

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The impact of consolidation on response rates and PFS has recently been demonstrated after induction and autotransplantation upfront in Multiple Myeloma (MM). We further showed that patients in ≥VGPR following the intensification procedure benefited most from consolidation. Question remains as to the benefit of consolidation for patients in PR at completion of induction - feature of partial resistance to the induction regimen.

We collected data from 54 newly diagnosed MM treated with VTd-auto-VTd regimen that reached only PR at completion of the induction procedure.

Overall, 37 patients (68%) improved depth of response (≥VGPR) at completion of consolidation, including 35% that reached CR and 38% solely related to consolidation. Of patients that remained on PR or improved depth of response after ASCT, 26% and 38% further responded to consolidation, respectively. With a median follow-up of 36 months, improved depth of response translated into lower relapse rate compared with patients remaining in PR, 19% vs. 36%. This difference was more striking in patients that reached CR vs. others, 8% and 38%, respectively (p=0.039). The median TTP was prolonged in patients that improved depth of response after consolidation (p=0.012), with a 3-year TTP of 87% vs. 18% otherwise. In multivariate analysis, lack of improved depth of response to consolidation independently predicted shorten median TTP [OR=4.4, 95%CI=1-21; p=0.039], with elevated LDH and beta2m, and adverse FISH.

This study shows that VTd consolidation should be recommended to patients solely on PR at completion of induction with VTd, feature of lower sensitivity to VTd.

Keywords: Consolidation, Partial response, Multiple Myeloma.