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In a letter to the editor of Leukemia, published in March 2017, Hermann Einsele and colleagues from the Julius-Maximilians-University of Würzburg present the case for the use of bortezomib as consolidation therapy for newly diagnosed multiple myeloma (MM) patients, following autologous stem cell transplantation (ASCT). Data were analyzed from two bortezomib phase 3 trials that assessed NDMM patients after ASCT, and stratified according to age and prior treatment regimens. Studies were carried out in 47 departments across Germany, between October 2006 and May 2013. The primary endpoint was progression free survival (PFS) from the start of induction therapy. Secondary endpoints assessed were event-free survival (EFS), from start of induction to start of new chemotherapy or death, response rates, overall survival (OS), quality of life, and safety.
Consolidation therapy with bortezomib (administered over a period of 5 months, 4 cycles), was well-tolerated and highly effective in delaying disease progression (6-month increase in PFS), as well as improving the quality of response in NDMM patients. Of note, improvements were seen in high-risk subsets: < VGPR after HDT/ASCT, del13q, t[4;14] or del17p, and, t(4;14), del 17p for which prognosis is generally low. In addition, a favorable response was independent of prior bortezomib treatment in the induction therapy.
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What is the most significant limitation you have identified when using lenalidomide or pomalidomide for the treatment of patients with multiple myeloma?