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| Pàgina inicial > Articles > Articles publicats > Curative Strategy for High-Risk Smoldering Myeloma : |
(Hospital Universitario de Salamanca) (Hospital Universitario 12 de Octubre (Madrid)) (Complejo Hospitalario de Navarra) (Hospital Universitario de Salamanca) (Hospital Clínico Universitario (Santiago de Compostela, Galícia)) (Institut Germans Trias i Pujol. Institut de Recerca contra la Leucèmia Josep Carreras) (Hospital Universitario de Salamanca) (Hospital Universitario Puerta de Hierro Majadahonda (Madrid)) (Hospital Clínic i Provincial de Barcelona) (Hospital Universitario Reina Sofía (Còrdova, Espanya)) (Hospital Universitari Son Llàtzer (Palma de Mallorca, Balears)) (Hospital Universitario Central de Asturias) (Hospital Universitario de la Princesa (Madrid)) (Hospital Universitario de León) (Hospital Universitari i Politècnic La Fe (València)) (Hospital Clínic Universitari (València)) (Hospital General Universitario Morales Meseguer (Múrcia)) (Hospital Clínico Universitario "Lozano Blesa" de Zaragoza) (Hospital Universitario de Canarias (La Laguna)) (Hospital Universitario Ramón y Cajal (Madrid)) (Hospital Universitario Virgen del Rocío (Sevilla, Andalusia)) (Hospital Universitario Marqués de Valdecilla (Santander, Cantabria)) (Complejo Hospitalario de Navarra) (Hospital Clínico Universitario (Salamanca)) (Hospital Universitario 12 de Octubre (Madrid)) (Hospital Clínic i Provincial de Barcelona) (Hospital Universitario 12 de Octubre (Madrid)) (Clínica Universidad de Navarra. Cancer Center)
| Data: | 2024 |
| Resum: | Early treatment of high-risk smoldering myeloma has been shown to delay progression to multiple myeloma (MM). We conducted this trial with curative intention using a treatment approach employed for newly diagnosed patients with MM. Patients with high-risk smoldering myeloma (>50% progression risk at 2 years) and transplant candidates were included and received induction therapy with carfilzomib, lenalidomide, and dexamethasone (KRd), six cycles, followed by high-dose melphalan (200 mg/m 2) autologous stem-cell transplantation (HDM-ASCT), two KRd consolidation cycles, and Rd maintenance for 2 years. The primary end point was undetectable measurable residual disease (uMRD) rate by next-generation flow after ASCT. Sustained uMRD 4 years after ASCT was the secondary end point. Between June 2015 and June 2017, 90 patients were included, and 31% met at least one SixtyLightchain MRI (SLiM)-hypercalcemia, renal impairment, anemia, bone disease (CRAB) criterion. After a median follow-up of 70. 1 months, 3 months after ASCT, in the intention-to-treat population, 56 (62%) of 90 patients had uMRD, and 4 years later, it was sustained in 29 patients (31%). Five patients progressed to MM, and the 70-month progression rate was 94% (95% CI, 84 to 89). The presence of any SLiM CRAB criteria predicted progression to MM (four of the five patients; hazard ratio, 0. 12; 95% CI, 0. 14 to 1. 13; P =. 03). Thirty-six patients showed biochemical progression, and failure to achieve uMRD at the end of treatment predicted it. The 70-month overall survival was 92% (95% CI, 82 to 89). Neutropenia and infections were the most frequent adverse events during treatment, resulting in one treatment-related death. Three second primary malignancies have been reported. Although a longer follow-up is needed, this curative approach is encouraging and more effective than active MM, with 31% of the patients maintaining the uMRD 4 years after HDM-ASCT. |
| Drets: | Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, i la comunicació pública de l'obra, sempre que no sigui amb finalitats comercials, i sempre que es reconegui l'autoria de l'obra original. No es permet la creació d'obres derivades.  |
| Llengua: | Anglès |
| Document: | Article ; recerca ; Versió publicada |
| Publicat a: | Journal of clinical oncology, Vol. 42 (July 2024) , p. 3247-3256, ISSN 1527-7755 |
