Administration of bortezomib before and after autologous stem-cell transplantation improves outcome in multiple myeloma patients with deletion 17p
Menée sur 354 patients atteints d'un myélome multiple, cette étude évalue les effets d'un traitement à base de bortezomib, avant et après une greffe autologue de cellules souches, en fonction de la présence d'une délétion du chromosome 17p13
In patients with Multiple Myeloma (MM), risk stratification by chromosomal abnormalities may enable a more rational selection of therapeutic approaches. Here we analyzed the prognostic value of 12 chromosomal abnormalities in a series of 354 MM patients treated within the HOVON-65/GMMG-HD4 trial. Because of the two-arm design of the study, we were able to analyze the effect of a bortezomib-based treatment before and after autologous stem-cell transplantation (arm B) in comparison to standard treatment without bortezomib (arm A). For all analyzed chromosomal aberrations, progression free survival (PFS) and overall survival (OS) were at least equal or superior in the bortezomib-arm as compared to the standard arm. Strikingly, patients with del(17p13) benefitted most from the bortezomib-containing treatment (median PFS time: A: 12.0 months, B: 26.2 months, p=0.024; 3yr-OS rates: A: 17%, B: 69%, p=0.028). After multivariate analysis, del(17p13) was an independent predictor for PFS (p<0.0001) and OS (p<0.0001) in arm A, whereas no statistical significant effect on PFS (p=0.28) and OS (p=0.12) was seen in arm B. In conclusion, the adverse impact of del(17p13) on PFS and OS could be significantly reduced by the bortezomib-based treatment, suggesting that long-term administration of bortezomib should be recommended for patients carrying del(17p13). This trial is registered at ISRCTN as ISRCTN64455289.