H e m a t o lo g y E d u c a t io n - European Hematology Association

16 th Congress of the European Hematology Association
again found to result in superior CR plus VGPR rates
both before and after ASCT. The reduction in the
doses of both bortezomib and thalidomide was associated
with a reduction in the incidence of neurotoxicity,
with grade 3–4 peripheral neuropathy (PN) occurring
in only 3% of the patients in the VTD arm. The
IFM2007-02 study therefore confirmed the superiority
of a 3-drug combination over a 2-drug combination as
induction prior to ASCT. The Hovon group recently
reported the final results of a phase 3 randomized
prospective trial comparing VAD versus PAD as induction
prior to HDT. This study confirmed the superiority
of the bortezomib-based triplet induction over VAD,
and OS was also superior in the bortezomib arm of the
trial. 26
No data are available to draw conclusions regarding the
superiority of one combination, VTD, RVD, VCD, PAD,
and so on, over the other. Although response rates are clearly
improved with novel agent cocktails, the demonstration
of a significant OS advantage will often be difficult given the
large number of patients and the long duration of follow-up
required, as well as the availability of effective salvage therapies.
Thus, based on response rates, depth of response, and
PFS as surrogate markers for outcome, 3-drug combinations,
as tested in the phase 2 and 3 studies described above, are,
in 2010, the standard of care prior to ASCT (Table 3). 27
Table 3. Response rates to novel-agent-containing induction therapy, and clinical outcomes after HDT-ASCT in phase III trials.
Abbreviations: CR, complete response; EFS, event-free survival; GEM, Grupo Español de Mieloma; GIMEMA, Gruppo Italiano Malattie Ematologiche dell’Adulto; HOVON, Hemato-Oncologie voor Volwassenen Nederland; IFM, Intergroupe Francophone
du Myèlome; nCR, near CR; NR, not reported; ORR, overall response rate; OS, overall survival; PETHEMA, Programa para el Estudio de la Terapéutica en Hemopatía Maligna; PFS, progression-free survival; TAD, thalidomide, doxorubicin, and dexamethasone;
TD, thalidomide and dexamethasone; VAD, vincristine, doxorubicin, and dexamethasone; VBMCP/VBAD, vincristine, carmustine, melphalan, cyclophosphamide, prednisone/vincristine, carmustine, doxorubicin, and dexamethasone; Vel, bortezomib;
Vel/Dex, bortezomib and dexamethasone; VGPR, very good partial response; VTD, bortezomib, thalidomide, and dexamethasone; PAD: bortezomib, doxorubicin and dexamethasone.
| 288 | Hematology Education: the education programme for the annual congress of the European Hematology Association | 2011; 5(1)