Intensification and consolidation therapy in multiple myeloma in the current era
Mené en Europe sur 1 503 patients atteints d’un myélome multiple de stade I à III récemment diagnostiqué (âge : 18-65 ans), cet essai de phase III compare l’efficacité, du point de vue de la survie sans progression entre la première et la deuxième randomisation, et la toxicité d’une greffe de cellules souches hématopoïétiques et d’un traitement par bortézomib, melphalan et prednisone (traitement de type VMP), avec ou sans traitement de consolidation par bortézomib, lénalidomide et dexaméthasone (traitement de type VRD)
Autologous haematopoietic stem-cell transplantation (HSCT) has been a cornerstone of multiple myeloma therapy for many decades owing to proven improvement in both progression-free survival and overall survival. However, the studies showing these improvements were carried out before the discovery of novel agents such as proteasome inhibitors, immunomodulatory agents, and monoclonal antibodies. Recent studies incorporating these novel agents with or without autologous HSCT have shown a continued progression-free survival advantage without an associated overall survival benefit. Several attempts have been made to improve intensification therapy with novel multi-agent combinations and double HSCT. These methods have yielded mixed results, presumably owing to differences in types of induction and maintenance therapy.
The Lancet Haematology , commentaire, 2019