The Latest Myeloma News from the American Society of Hematology Meeting

Andrew Schorr:

Wow. Very positive. Now, Dr. Lonial, you are involved in transplant as well, and I know there was data saying, and I think Dr. Durie was just talking about it, could there be new combinations to prepare someone for a transplant, make that transplant more effective, and where otherwise maybe there's the worry would they need a second transplant, maybe make that less likely? Could you comment on that?

Dr. Lonial:

Yes. I think, and Dr. Durie hit on a lot of the major issues in this topic, historically it has not mattered what you gave patients prior to collecting stem cells and moving forward with high dose therapy and transplant, and this ASH was one of the first meetings where we saw that that may in fact not be the case, and there were two trials, both from Europe, one from Italy and one from France that looked at bortezomib-based inductions in the newly-diagnosed patient setting, and patients were randomized to either bortezomib and dexamethasone versus VAD, which is a European standard, or in the Italian study Velcade with thalidomide and dexamethasone compared with thalidomide and dexamethasone, and in both those trials, the two arms that contained Velcade in the induction not only had higher response rates up front but also had higher response rates and complete remissions following high-dose therapy in autologous transplant. I think we have to step back a moment and realize that this is really a landmark finding because up until now it didn't matter what you gave patients. Their post-transplant response was always the same because transplant was doing most of the work at generating the remissions or the complete remissions, whereas what we can see from these two large European studies, what you give in the beginning, the Velcade-containing regimens up front, really did seem to make a difference in what happened after transplant, and I think a number of us still want to see whether that increased rate of remissions translates into a longer duration of remission. That really is one of the big questions that I think we have answers to as yet.

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Page last updated on November 22, 2013