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Lenalidomide versus bortezomib maintenance after frontline autologous stem cell transplantation for multiple myeloma

Affiliation
Department of Internal Medicine V, University Hospital Heidelberg, Heidelberg, Germany
Baertsch, Marc-Andrea;
Affiliation
Department of Internal Medicine V, University Hospital Heidelberg, Heidelberg, Germany
Mai, Elias K.;
Affiliation
Division of Biostatistics, German Cancer Research Center (DKFZ), Heidelberg, Germany
Hielscher, Thomas;
Affiliation
Department of Internal Medicine V, University Hospital Heidelberg, Heidelberg, Germany
Bertsch, Uta;
Affiliation
Asklepios Tumorzentrum Hamburg, AK Altona and AK St. Georg, Hamburg, Germany
Salwender, Hans J.;
Affiliation
Department of Internal Medicine III, University Medical Center Mainz, Mainz, Germany
Munder, Markus;
Affiliation
Department of Hematology and Stem Cell Transplantation, Helios Hospital Berlin Buch, Berlin, Germany
Fuhrmann, Stephan;
Affiliation
Department of Hematology, University Clinic Essen, Essen, Germany
Dührsen, Ulrich;
Affiliation
University Hospital Bonn, Bonn, Germany
Brossart, Peter;
Affiliation
Department of Hematology and Oncology, Klinikum Baden Baden, Baden Baden, Germany
Neben, Kai;
Affiliation
Department of Internal Medicine V, University Hospital Heidelberg, Heidelberg, Germany
Schlenzka, Jana;
GND
1206902620
Affiliation
Max Rubner-Institut (MRI), Department of Child Nutrition, Germany
Kunz, Christina;
Affiliation
Department of Internal Medicine V, University Hospital Heidelberg, Heidelberg, Germany
Raab, Marc S.;
Affiliation
Department of Internal Medicine V, University Hospital Heidelberg, Heidelberg, Germany
Hillengaß, Jens;
Affiliation
Institute of Human Genetics, University of Heidelberg, Heidelberg, Germany
Jauch, Anna;
Affiliation
Department of Internal Medicine V, University Hospital Heidelberg, Heidelberg, Germany
Seckinger, Anja;
Affiliation
Department of Internal Medicine V, University Hospital Heidelberg, Heidelberg, Germany
Hose, Dirk;
Affiliation
Coordination Centre for Clinical Trials (KKS) Heidelberg, Heidelberg, Germany
Luntz, Steffen;
Affiliation
Department of Hematology, Erasmus MC Cancer Institute, Rotterdam, Netherlands
Sonneveld, Pieter;
Affiliation
Department of Hematology, VU University Medical Center, Amsterdam, Netherlands
Lokhorst, Henk;
Affiliation
Department of Medicine, Hematology/Oncology, Goethe-University of Frankfurt, Frankfurt, Germany
Martin, Hans;
Affiliation
Department of Hematology, Oncology and Palliative Care, Klinikum Bielefeld, Bielefeld, Germany
Goerner, Martin;
Affiliation
Medical Clinic A, Klinikum Ludwigshafen, Ludwigshafen, Germany
Hoffmann, Martin;
Affiliation
Department of Hematology and Oncology, Katholisches Krankenhaus Hagen, Hagen, Germany
Lindemann, Hans-Walter;
Affiliation
Internal Medicine V, Klinikum Darmstadt, Darmstadt, Germany
Bernhard, Helga;
Affiliation
Medical Clinic, Charité University Medicine Berlin, Berlin, Germany
Blau, Igor W.;
Affiliation
Department of Internal Medicine I, University Hospital Köln, Köln, Germany
Scheid, Christof;
Affiliation
Department of Hematology, Oncology and Immunology, University Hospital Tübingen, Tübingen, Germany
Besemer, Britta;
Affiliation
Department of Oncology, Hematology and Bone Marrow Transplantation with Section of Pneumology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
Weisel, Katja C.;
Affiliation
Department of Internal Medicine III, Klinikum Chemnitz, Chemnitz, Germany
Hänel, Mathias;
Affiliation
Department of Hematology, University Clinic Essen, Essen, Germany
Dürig, Jan;
Affiliation
Department of Internal Medicine V, University Hospital Heidelberg, Heidelberg, Germany
Goldschmidt, Hartmut

Lenalidomide (LEN) maintenance (MT) post autologous stem cell transplantation (ASCT) is standard of care in newly diagnosed multiple myeloma (MM) but has not been compared to other agents in clinical trials. We retrospectively compared bortezomib (BTZ; n = 138) or LEN (n = 183) MT from two subsequent GMMG phase III trials. All patients received three cycles of BTZ-based triplet induction and post-ASCT MT. BTZ MT (1.3 mg/m² i.v.) was administered every 2 weeks for 2 years. LEN MT included two consolidation cycles (25 mg p.o., days 1–21 of 28 day cycles) followed by 10–15 mg/day for 2 years. The BTZ cohort more frequently received tandem ASCT (91% vs. 33%) due to different tandem ASCT strategies. In the LEN and BTZ cohort, 43% and 46% of patients completed 2 years of MT as intended (p = 0.57). Progression-free survival (PFS; HR = 0.83, p = 0.18) and overall survival (OS; HR = 0.70, p = 0.15) did not differ significantly with LEN vs. BTZ MT. Patients with <nCR after first ASCT were assigned tandem ASCT in both trials. In patients with <nCR and tandem ASCT (LEN: n = 54 vs. BTZ: n = 84), LEN MT significantly improved PFS (HR = 0.61, p = 0.04) but not OS (HR = 0.46, p = 0.09). In conclusion, the significant PFS benefit after eliminating the impact of different tandem ASCT rates supports the current standard of LEN MT after ASCT.

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