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Rapid early monoclonal protein reduction after therapy with bortezomib or bortezomib and pegylated liposomal doxorubicin in relapsed/refractory myeloma is associated with a longer time to progression
Article first published online: 15 FEB 2011
Copyright © 2011 American Cancer Society
Volume 117, Issue 16, pages 3758–3762, 15 August 2011
How to Cite
Shah, J., Bladé, J., Sonneveld, P., Harousseau, J.-L., Lantz, K., Londhe, A., Lowery, C. and Orlowski, R. Z. (2011), Rapid early monoclonal protein reduction after therapy with bortezomib or bortezomib and pegylated liposomal doxorubicin in relapsed/refractory myeloma is associated with a longer time to progression. Cancer, 117: 3758–3762. doi: 10.1002/cncr.25937
- Issue published online: 3 AUG 2011
- Article first published online: 15 FEB 2011
- Manuscript Accepted: 22 DEC 2010
- Manuscript Revised: 4 NOV 2010
- Manuscript Received: 2 SEP 2010
- relapsed/refractory multiple myeloma;
- pegylated liposomal doxorubicin;
- monoclonal (M) protein;
- response rapidity
A rapid and early monoclonal (M) protein response during initial therapy in patients with multiple myeloma had been identified as a predictor of superior long-term outcome in some—but not all—studies.
To determine if the parameter of M protein reduction was of value in the relapsed and/or refractory setting, retrospective landmark analyses were performed at the end of cycles 2 and 4 of a phase 3 study, which randomized such patients to receive bortezomib alone or pegylated liposomal doxorubicin (PLD) with bortezomib.
Compared with a <25% reduction in M protein at the landmark time point, patients with a 50% to <75% reduction after cycle 2 had a significantly lower hazard ratio (HR) for time to progression (HR = 0.41; 95% confidence interval [CI], 0.26-0.64; P <.001), as did those with a ≥75% reduction (HR = 0.26; 95% CI, 0.15-0.45; P < .001). In all of these groups, PLD + bortezomib provided superior outcomes to bortezomib alone, and did so without an increase in the risk of adverse events overall and with a predictable toxicity profile.
These analyses supported the possibility that a robust early M protein response is a good prognostic factor for long-term outcome of myeloma patients with relapsed and/or refractory disease receiving bortezomib or PLD + bortezomib. Cancer 2011;. © 2011 American Cancer Society.