• Chor Sang Chim, Albert Kwok Wai Lie, Eric Yuk Tat Chan, Herman Sung Yu Liu, Ching Wa Lau, YipSze FaiSF, Joycelyn Sim, Thomas Shek-Kong Wan, Edmond Shiu-Kwan Ma, Raymond Liang, Eric Tse, Yok-Lam Kwong, and Hong Kong Society of Myeloma.
• Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong, Hong Kong. jcschim@hku.hk
• J Hematol Oncol. 2012 Jun 8; 5: 28.

BackgroundWe have reported promising outcomes using a staged approach, in which bortezomib/thalidomide/dexamethasone was used only in 14 patients with suboptimal response to VAD (vincristine/adriamycin/dexamethasone) before autologous stem cell transplantation (ASCT). Here we compared the outcomes of the staged approach with frontline PAD (bortezomib/doxorubicin/dexamethasone) or VTD (bortezomib/thalidomide/dexamethasone) induction, and analysed prognostic factors for outcome.Patients And MethodsNinety-one transplant-eligible Chinese patients received three induction regimens prior to ASCT [staged approach (N = 25), PAD (N = 31), VTD (N = 35)]. and received thalidomide maintenance for 2 years post-ASCT.Results43 (47.3%) patients had International Staging System (ISS) III disease. By an intention-to-treat analysis, the overall CR/nCR rate were 37.4% post-induction, and 62.6% post-ASCT. Five-year overall (OS) and event-free (EFS) survivals were 66% and 45.1%. There was no difference of the post-induction CR/nCR rate, EFS or OS between patients induced by these three regimens. Moreover, ISS III disease did not affect CR/nCR rates. Multivariate analysis showed that ISS and post-ASCT CR/nCR impacted OS while ISS and post-induction CR/nCR impacted EFS.ConclusionsThese three induction regimens produced comparable and favorable outcomes in myeloma. The unfavorable outcome of ISS stage III persisted despite upfront/early use of bortezomib. CR/nCR predicted favorable survivals.

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