Total therapy 2 without thalidomide in comparison with total therapy 1: Role of intensified induction and posttransplantation consolidation therapies

Bart Barlogie, Guido Tricot, Erik Rasmussen, Elias Anaissie, Frits Van Rhee, Maurizio Zangari, Athanasios Fassas, Klaus Hollmig, Mauricio Pineda-Roman, John Shaughnessy, Joshua Epstein, John Crowley

Research output: Contribution to journalArticle

102 Citations (Scopus)

Abstract

Patients with myeloma, treated on the thalidomide arm of total therapy 2 (TT2), had a higher complete response (CR) rate and improved event-free survival (EFS) but not overall survival (OS). To evaluate the benefit of TT2's posttandem autotransplant consolidation chemotherapy and dexamethasone maintenance, outcomes were compared on TT2 without thalidomide (n = 345; median follow-up, 3.5 years) and on predecessor trial TT1 (n = 231; median follow-up, 11.5 years). CR rates were similar (43% vs 41%); however, 5-year estimates of continuous CR (45% vs 32%, P < .001) and 5-year EFS (43% vs 28%, P < .001) were superior with TT2, with a trend for improved OS (62% vs 57%; P = .11). OS was also superior among patients achieving CR and receiving the second transplantation early after the first transplantation. Superior EFS and OS with TT2 versus TT1 was noted in the two thirds presenting without cytogenetic abnormalities (CAs); 4-year posttandem transplantation OS for patients with CAs was 47% with TT1 and 76% with TT2 when combination chemotherapy rather than DEX was applied for consolidation (P = .040). Thus, TT2 (without thalidomide) improved OS of patients without CAs; those with CAs benefited from posttransplantation consolidation chemotherapy. The favorable effects of CR and rapidly sequenced second transplantation attest to the validity of a melphalan dose-response effect in myeloma.

Original languageEnglish (US)
Pages (from-to)2633-2638
Number of pages6
JournalBlood
Volume107
Issue number7
DOIs
StatePublished - Apr 1 2006

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Thalidomide
Chemotherapy
Consolidation
Chromosome Aberrations
Survival
Transplantation
Consolidation Chemotherapy
Disease-Free Survival
Melphalan
Autografts
Dexamethasone
Therapeutics
Combination Drug Therapy
Arm
Maintenance

ASJC Scopus subject areas

  • Hematology

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Total therapy 2 without thalidomide in comparison with total therapy 1 : Role of intensified induction and posttransplantation consolidation therapies. / Barlogie, Bart; Tricot, Guido; Rasmussen, Erik; Anaissie, Elias; Van Rhee, Frits; Zangari, Maurizio; Fassas, Athanasios; Hollmig, Klaus; Pineda-Roman, Mauricio; Shaughnessy, John; Epstein, Joshua; Crowley, John.

In: Blood, Vol. 107, No. 7, 01.04.2006, p. 2633-2638.

Research output: Contribution to journalArticle

Barlogie, B, Tricot, G, Rasmussen, E, Anaissie, E, Van Rhee, F, Zangari, M, Fassas, A, Hollmig, K, Pineda-Roman, M, Shaughnessy, J, Epstein, J & Crowley, J 2006, 'Total therapy 2 without thalidomide in comparison with total therapy 1: Role of intensified induction and posttransplantation consolidation therapies', Blood, vol. 107, no. 7, pp. 2633-2638. https://doi.org/10.1182/blood-2005-10-4084
Barlogie, Bart ; Tricot, Guido ; Rasmussen, Erik ; Anaissie, Elias ; Van Rhee, Frits ; Zangari, Maurizio ; Fassas, Athanasios ; Hollmig, Klaus ; Pineda-Roman, Mauricio ; Shaughnessy, John ; Epstein, Joshua ; Crowley, John. / Total therapy 2 without thalidomide in comparison with total therapy 1 : Role of intensified induction and posttransplantation consolidation therapies. In: Blood. 2006 ; Vol. 107, No. 7. pp. 2633-2638.
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AU - Zangari, Maurizio

AU - Fassas, Athanasios

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AB - Patients with myeloma, treated on the thalidomide arm of total therapy 2 (TT2), had a higher complete response (CR) rate and improved event-free survival (EFS) but not overall survival (OS). To evaluate the benefit of TT2's posttandem autotransplant consolidation chemotherapy and dexamethasone maintenance, outcomes were compared on TT2 without thalidomide (n = 345; median follow-up, 3.5 years) and on predecessor trial TT1 (n = 231; median follow-up, 11.5 years). CR rates were similar (43% vs 41%); however, 5-year estimates of continuous CR (45% vs 32%, P < .001) and 5-year EFS (43% vs 28%, P < .001) were superior with TT2, with a trend for improved OS (62% vs 57%; P = .11). OS was also superior among patients achieving CR and receiving the second transplantation early after the first transplantation. Superior EFS and OS with TT2 versus TT1 was noted in the two thirds presenting without cytogenetic abnormalities (CAs); 4-year posttandem transplantation OS for patients with CAs was 47% with TT1 and 76% with TT2 when combination chemotherapy rather than DEX was applied for consolidation (P = .040). Thus, TT2 (without thalidomide) improved OS of patients without CAs; those with CAs benefited from posttransplantation consolidation chemotherapy. The favorable effects of CR and rapidly sequenced second transplantation attest to the validity of a melphalan dose-response effect in myeloma.

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