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Real world outcomes with Bortezomib Thalidomide dexamethasone and Cyclophosphamide Bortezomib dexamethasone induction treatment for transplant eligible multiple myeloma patients in a Latin American country. A Retrospective Cohort Study from Grupo Argentino de Mieloma Múltiple.
Schütz, Natalia P; Ochoa, Paola; Duarte, Patricio; Remaggi, Guillermina; Yantorno, Sebastián; Corzo, Ariel; Zabaljauregui, Soledad; Shanley, Claudia; Lopresti, Sergio; Orlando, Sergio; Verri, Verónica; Quiroga, Luis; García, Carlos A; Fernández, Vanesa; Fantl, Dorotea.
Afiliación
  • Schütz NP; Hospital Italiano de Buenos Aires - Servicio de Clínica Médica (Sección Hematología), Buenos Aires, Argentina.
  • Ochoa P; Instituto Alexander Fleming - Departamento de Hematología, Buenos Aires, Argentina.
  • Duarte P; CEMIC - Sección Hematología, Buenos Aires, Argentina.
  • Remaggi G; FUNDALEU - Departamento de Trasplante de Médula ósea, Buenos Aires, Argentina.
  • Yantorno S; Hospital Italiano de La Plata - Servicio de Hematología (Unidad de Trasplante de Médula ósea), Buenos Aires, Argentina.
  • Corzo A; Hospital de Clínicas "José de San Martín" - Departamento de Clínica Médica (División Hematología), Buenos Aires, Argentina.
  • Zabaljauregui S; Academia Nacional de Medicina - Departamento de Hemato-Oncología (División Oncohematología), Buenos Aires, Argentina.
  • Shanley C; Hospital Británico - Departamento de Hematología (Unidad de Trasplante de Médula ósea), Buenos Aires, Argentina.
  • Lopresti S; Hospital Posadas - Departamento de Medicina Interna, Morón, Argentina.
  • Orlando S; Hospital Rodolfo Rossi - Departamento de Hematología y Trasplante de Médula ósea, La Plata, Argentina.
  • Verri V; Instituto de Investigaciones Médicas "Alfredo Lanari" UBA - Departamento de Hematología, Buenos Aires, Argentina.
  • Quiroga L; Complejo Médico de la Policía Federal Argentina Churruca Visca - Departamento de Clínica Médica (Sección Hematología), Buenos Aires, Argentina.
  • García CA; Clínica 25 de Mayo, Mar del Plata, Argentina.
  • Fernández V; Sanatorio Dr. Julio Méndez - Departamento de Clínica Médica (Sección Hematología), Buenos Aires, Argentina.
  • Fantl D; Hospital Italiano de Buenos Aires - Servicio de Clínica Médica (Sección Hematología), Buenos Aires, Argentina.
Hematol Oncol ; 38(3): 363-371, 2020 Aug.
Article en En | MEDLINE | ID: mdl-32196120
Data about treatment outcomes and toxicity in Latin America are scarce. There are differences with central countries based on access to healthcare system and socioeconomic status. Argentinean Society of Hematology recommends bortezomib-based triplets for induction treatment of transplant eligible newly diagnosed multiple myeloma patients. Most common options are CyBorD (cyclophosphamide, bortezomib and dexamethasone) and VTD (bortezomib, thalidomide and dexamethasone). Main goal of our retrospective, multicentric study was to compare very good partial response rate (VGPR) or better after induction treatment in a real-world setting in Argentina. Secondary objectives included comparison of complete response (CR) post-induction and after bone marrow transplantation, grade 3-4 adverse events (AEs), progression-free survival (PFS) and overall survival (OS). Three hundred twenty-two patients were included (median age at diagnosis: 57 years; 52% male; 28% had ISS3; 14% with high-risk cytogenetics; median follow up: 34 months). CyBorD was indicated in 74% and 26% received VTD. In VTD arm, 72.62% of patients achieved at least VGPR vs 53.36% receiving CyBorD (odds ratio, OR: 1.96 [95% confidence interval, CI: 1.08-3.57; P = .026] after adjusting by age, ISS [International Staging System], lactate dehydrogenase levels (LDH) and cytogenetic risk. Difference in VGPR was 19.26% (95% CI: 15-24). CR rate were 35.92% (VTD) vs 22.55% (CyBorD) (adjusted OR: 2.13 [95% CI: 1.12-4.05]). Difference in CR was 13.37% (95% CI: 9.6-17.53). Adverse events (AEs) were more common with VTD (69.05% vs 55.46% for CyBorD; P = .030), especially grade 3-4 neuropathy (P = .005) and thrombosis (P = .001). Thromboprophylaxis was inadequate in 20.24% of patients. Hematological AEs were more common with CyBorD, especially thrombocytopenia (P = .017). PFS and OS at 24 months were not different between treatments. In this real-world setting, VTD was associated with better CR and VGPR than CyBorD. Nevertheless, CyBorD continues to be the preferred induction regimen in Argentina, based on safety profile. Frontline autologous stem cell transplantation improves quality of responses, especially in countries with limited access to new drugs.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Protocolos de Quimioterapia Combinada Antineoplásica / Quimioterapia de Inducción / Mieloma Múltiple Tipo de estudio: Etiology_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Aged / Female / Humans / Male / Middle aged País/Región como asunto: America do sul / Argentina Idioma: En Revista: Hematol Oncol Año: 2020 Tipo del documento: Article País de afiliación: Argentina Pais de publicación: Reino Unido

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Protocolos de Quimioterapia Combinada Antineoplásica / Quimioterapia de Inducción / Mieloma Múltiple Tipo de estudio: Etiology_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Aged / Female / Humans / Male / Middle aged País/Región como asunto: America do sul / Argentina Idioma: En Revista: Hematol Oncol Año: 2020 Tipo del documento: Article País de afiliación: Argentina Pais de publicación: Reino Unido