Among patients who have received high-dose melphalan and an autologous stem cell transplant for initial treatment of multiple myeloma, Velcade® (bortezomib) appears to improve treatment response rates. These results were presented at the 2009 meeting of the American Society of Hematology (ASH).
Multiple myeloma is a cancer of plasma cells. Plasma cells are a special type of white blood cell that are part of the body’s immune system. Plasma cells normally live in the bone marrow and make proteins, called antibodies, that circulate in the blood and help fight certain types of infections. Plasma cells also play a role in the maintenance of bone, by secretion of a hormone, called osteoclast activating factor, which causes the breakdown of bone. Patients with multiple myeloma have increased numbers of abnormal plasma cells that may produce increased quantities of dysfunctional antibodies detectable in the blood and/or urine. These abnormal antibodies are referred to as paraproteins or monoclonal proteins in the blood (M proteins) or urine (Bence Jones protein).
A common treatment for multiple myeloma is high-dose therapy followed by autologous stem cell transplant. High doses of chemotherapy are more effective at killing cancer cells than lower doses. However, high-dose therapy destroys many other cells in the body, including stem cells in the bone marrow that develop into mature blood cells. A stem cell transplant restores these blood stem cells. An autologous stem cell transplant makes use of the patient’s own blood stem cells, which are collected prior to high-dose therapy.
Velcade is the first in a new class of anticancer agents known as proteasome inhibitors. Current studies are being carried out to determine the best way to incorporate Velcade into initial transplant and non-transplant treatment regimens for newly diagnosed patients with multiple myeloma.
The current study involved 372 patients who had received an autologous stem cell transplant after high-dose melphalan. Patients were randomly assigned to receive consolidation therapy with Velcade or no further therapy. Preliminary analysis of outcomes in 299 patients were presented:
- Nine months after transplantation, the CR/nCR rates were 54% for the Velcade group and 35% for the comparison group.
- The proportion of patients improving from PR to CR/nCr was 20% for the Velcade group and 12% for the comparison group.
These data suggest that Velcade given as consolidation therapy after high-dose melphalan improves treatment response rates. Whether or not this approach will improve survival remains to be determined.
Reference: Mellqvist U-H, Westin J, Gimsing P, et al. Improved response rate with bortezomib consolidation after high dose melphalan: First results of a Nordic Myeloma Study Group randomized phase III trial. Blood. 2009;114:221, abstract 530.
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