TY - JOUR
T1 - Pharmacokinetics-directed Intravenous Busulfan Combined With High-dose Melphalan and Bortezomib as a Conditioning Regimen for Patients With Multiple Myeloma
AU - Barta, Stefan K.
AU - Jain, Rishi
AU - Mazumder, Amithaba
AU - Carter, Jason
AU - Almanzar, Lawrence
AU - Browne, Roy
AU - Shahnaz, Samira
AU - Elkind, Richard
AU - Kaminetzky, David
AU - Battini, Ramakrishna
AU - Derman, Olga
AU - Kornblum, Noah
AU - Verma, Amit
AU - Braunschweig, Ira
N1 - Publisher Copyright:
© 2017 Elsevier Inc.
PY - 2017/10
Y1 - 2017/10
N2 - We explored safety and efficacy of the combination of pharmacokinetics-directed busulfan, melphalan and bortezomib as conditioning regimen for autologous stem cell transplantation in multiple myeloma. In this prospective phase II trial, 19 patients were treated and achieved an overall response rate of 100% and a 2-year progression-free survival and overall survival of 57.9% and 88.5% respectively with acceptable toxicities. This suggests the combination is effective and safe. Background High-dose chemotherapy followed by autologous stem cell transplantation (ASCT) has a well-established role in the treatment of patients with multiple myeloma. Melphalan 200 mg/m2 (Mel200) is the most commonly used preparative regimen. Several studies have provided evidence for potential synergism and safety when combining bortezomib (Btz) or busulfan (Bu) with melphalan (Mel). Patients and Methods We conducted a prospective phase II study to investigate the safety and efficacy of conditioning with pharmacokinetics (PK)-directed intravenous (IV) Bu with Btz and Mel. Bu dosing was adjusted to target a total area under the curve (AUC) of 20,000 μM × min. Patients received Btz (1 mg/m2 × 4 doses) and Mel (140 mg/m2). Results A total of 19 subjects were enrolled. Their median age was 55 years, and the median follow-up period was 23.7 months. PK testing resulted in 86% of patients achieving an estimated total AUC of 20,000 ± 2500 μM × min. The overall response rate (ORR) at day +100 after ASCT was 100% in the evaluable patients, with 11% of patients achieving a complete response. The 2-year progression-free survival rate was 57.9% (95% confidence interval [CI], 38%-89%), and the 2-year overall survival rate was 88.5% (95% CI, 76%-100%). The most common grade 3 and 4 toxicities were febrile neutropenia, dysphagia/odynophagia, and oral mucositis. No case of hepatic sinusoidal obstruction syndrome developed. One treatment-related mortality occurred before day +100. Conclusion A preparative regimen of PK-directed IV Bu with Btz and Mel led to an ORR of 100% with acceptable toxicity and should be considered for direct comparison with the Mel200 regimen in future trials.
AB - We explored safety and efficacy of the combination of pharmacokinetics-directed busulfan, melphalan and bortezomib as conditioning regimen for autologous stem cell transplantation in multiple myeloma. In this prospective phase II trial, 19 patients were treated and achieved an overall response rate of 100% and a 2-year progression-free survival and overall survival of 57.9% and 88.5% respectively with acceptable toxicities. This suggests the combination is effective and safe. Background High-dose chemotherapy followed by autologous stem cell transplantation (ASCT) has a well-established role in the treatment of patients with multiple myeloma. Melphalan 200 mg/m2 (Mel200) is the most commonly used preparative regimen. Several studies have provided evidence for potential synergism and safety when combining bortezomib (Btz) or busulfan (Bu) with melphalan (Mel). Patients and Methods We conducted a prospective phase II study to investigate the safety and efficacy of conditioning with pharmacokinetics (PK)-directed intravenous (IV) Bu with Btz and Mel. Bu dosing was adjusted to target a total area under the curve (AUC) of 20,000 μM × min. Patients received Btz (1 mg/m2 × 4 doses) and Mel (140 mg/m2). Results A total of 19 subjects were enrolled. Their median age was 55 years, and the median follow-up period was 23.7 months. PK testing resulted in 86% of patients achieving an estimated total AUC of 20,000 ± 2500 μM × min. The overall response rate (ORR) at day +100 after ASCT was 100% in the evaluable patients, with 11% of patients achieving a complete response. The 2-year progression-free survival rate was 57.9% (95% confidence interval [CI], 38%-89%), and the 2-year overall survival rate was 88.5% (95% CI, 76%-100%). The most common grade 3 and 4 toxicities were febrile neutropenia, dysphagia/odynophagia, and oral mucositis. No case of hepatic sinusoidal obstruction syndrome developed. One treatment-related mortality occurred before day +100. Conclusion A preparative regimen of PK-directed IV Bu with Btz and Mel led to an ORR of 100% with acceptable toxicity and should be considered for direct comparison with the Mel200 regimen in future trials.
KW - Autologous stem cell transplant
KW - High-dose chemotherapy
KW - Personalized medicine
KW - Proteasome inhibition
KW - Targeted therapy
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U2 - 10.1016/j.clml.2017.06.005
DO - 10.1016/j.clml.2017.06.005
M3 - Article
C2 - 28684379
AN - SCOPUS:85023777215
SN - 2152-2669
VL - 17
SP - 650
EP - 657
JO - Clinical Lymphoma
JF - Clinical Lymphoma
IS - 10
ER -