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Article: A staged approach with vincristine, adriamycin and dexamethasone followed by bortezomib, thalidomide and dexamethasone before autologous hematopoietic stem cell transplantation in the treatment of newly diagnosed multiple myeloma

TitleA staged approach with vincristine, adriamycin and dexamethasone followed by bortezomib, thalidomide and dexamethasone before autologous hematopoietic stem cell transplantation in the treatment of newly diagnosed multiple myeloma
Authors
KeywordsCNS disease
Oligoclonal reconstitution
Staged approach
Survival
VAD
VTD
Issue Date2010
PublisherSpringer Verlag. The Journal's web site is located at http://link.springer.de/link/service/journals/00277/index.htm
Citation
Annals of Hematology, 2010, v. 89 n. 10, p. 1019-1027 How to Cite?
AbstractBortezomib-based regimens have significant activities in multiple myeloma (MM). In this study, we tested the efficacy of a total therapy with a staged approach where newly diagnosed MM patients received vincristine/adriamycin/dexamethsone (VAD). VAD-sensitive patients (> or =75% paraprotein reduction) received autologous hematopoietic stem cell transplantation (auto-HSCT), whereas less VAD-sensitive patients (<75% paraprotein reduction) received bortezomib/thalidomide/dexamethasone (VTD) for further cytoreduction prior to auto-HSCT. On an intention-to-treat analysis, a progressive increase of complete remission (CR) rates was observed, with cumulative CR rates of 48% after HSCT. Seven patients progressed leading to three fatalities, of which two had central nervous system disease. The 3-year overall survival and event-free survival were 75.1% and 48.3%, respectively. Six patients developed oligoclonal reconstitution with new paraproteins. In the absence of anticoagulant prophylaxis, no patients developed deep vein thrombosis. The staged application of VAD+/-VTD/auto-HSCT resulted in an appreciable response rate and promising survivals. Our approach reduced the use of bortezomib without compromising the ultimate CR rate and is of financial significance for less affluent communities.
Persistent Identifierhttp://hdl.handle.net/10722/124026
ISSN
2023 Impact Factor: 3.0
2023 SCImago Journal Rankings: 0.912
PubMed Central ID
ISI Accession Number ID
Funding AgencyGrant Number
bortezomib
Funding Information:

We thank Drs Joyce Chan, Bonnie Khoo, Herman Liu, Thomas Lau from Pamela Youde Nethersole East Hospital; Drs Dominic Yeung, M.F. Law, Candia Chan and L.G. Wong from Tuen Mun Hospital; Drs K.K. Lee, Joycelyn Sim, Vivien Mak and Sandy Ho from Princess Margaret Hospital, for their patient referral and management. We also thank Mr Edwin Leong for funding support of bortezomib.

 

DC FieldValueLanguage
dc.contributor.authorChim, CSen_HK
dc.contributor.authorLie, AKWen_HK
dc.contributor.authorChan, EYTen_HK
dc.contributor.authorLeung, YYen_HK
dc.contributor.authorCheung, SCWen_HK
dc.contributor.authorChan, SYTen_HK
dc.contributor.authorLiang, Ren_HK
dc.contributor.authorKwong, YLen_HK
dc.date.accessioned2010-10-19T04:34:10Z-
dc.date.available2010-10-19T04:34:10Z-
dc.date.issued2010en_HK
dc.identifier.citationAnnals of Hematology, 2010, v. 89 n. 10, p. 1019-1027en_HK
dc.identifier.issn0939-5555en_HK
dc.identifier.urihttp://hdl.handle.net/10722/124026-
dc.description.abstractBortezomib-based regimens have significant activities in multiple myeloma (MM). In this study, we tested the efficacy of a total therapy with a staged approach where newly diagnosed MM patients received vincristine/adriamycin/dexamethsone (VAD). VAD-sensitive patients (> or =75% paraprotein reduction) received autologous hematopoietic stem cell transplantation (auto-HSCT), whereas less VAD-sensitive patients (<75% paraprotein reduction) received bortezomib/thalidomide/dexamethasone (VTD) for further cytoreduction prior to auto-HSCT. On an intention-to-treat analysis, a progressive increase of complete remission (CR) rates was observed, with cumulative CR rates of 48% after HSCT. Seven patients progressed leading to three fatalities, of which two had central nervous system disease. The 3-year overall survival and event-free survival were 75.1% and 48.3%, respectively. Six patients developed oligoclonal reconstitution with new paraproteins. In the absence of anticoagulant prophylaxis, no patients developed deep vein thrombosis. The staged application of VAD+/-VTD/auto-HSCT resulted in an appreciable response rate and promising survivals. Our approach reduced the use of bortezomib without compromising the ultimate CR rate and is of financial significance for less affluent communities.en_HK
dc.languageengen_HK
dc.publisherSpringer Verlag. The Journal's web site is located at http://link.springer.de/link/service/journals/00277/index.htmen_HK
dc.relation.ispartofAnnals of Hematologyen_HK
dc.rightsThis work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.en_HK
dc.subjectCNS disease-
dc.subjectOligoclonal reconstitution-
dc.subjectStaged approach-
dc.subjectSurvival-
dc.subjectVAD-
dc.subjectVTD-
dc.subject.meshAntineoplastic Agents - therapeutic use-
dc.subject.meshAntineoplastic Combined Chemotherapy Protocols - therapeutic use-
dc.subject.meshBoronic Acids - therapeutic use-
dc.subject.meshHematopoietic Stem Cell Transplantation-
dc.subject.meshMultiple Myeloma - diagnosis - pathology - physiopathology - therapy-
dc.titleA staged approach with vincristine, adriamycin and dexamethasone followed by bortezomib, thalidomide and dexamethasone before autologous hematopoietic stem cell transplantation in the treatment of newly diagnosed multiple myelomaen_HK
dc.typeArticleen_HK
dc.identifier.emailChim, CS: jcschim@hku.hk-
dc.identifier.emailLiang, R: rliang@hku.hk-
dc.identifier.emailKwong, YL: ylkwong@hku.hk-
dc.description.naturepublished_or_final_version-
dc.identifier.doi10.1007/s00277-010-0959-4en_HK
dc.identifier.pmid20428873-
dc.identifier.pmcidPMC2924968-
dc.identifier.scopuseid_2-s2.0-77956707989-
dc.identifier.hkuros172201-
dc.identifier.volume89en_HK
dc.identifier.issue10en_HK
dc.identifier.spage1019en_HK
dc.identifier.epage1027en_HK
dc.identifier.eissn1432-0584en_HK
dc.identifier.isiWOS:000281161400010-
dc.publisher.placeGermany-
dc.description.otherSpringer Open Choice, 01 Dec 2010-
dc.identifier.citeulike7151235-
dc.identifier.issnl0939-5555-

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