Impact of the changing landscape of induction therapy prior to autologous stem cell transplantation in 540 myeloma patients: a retrospective real-world study

Background High-dose therapy followed by autologous stem cell transplantation (ASCT) is the standard first line treatment for younger patients (pts) ( Methods This analysis included all consecutive pts with newly diagnosed MM who received first line induction therapy followed by high-dose therapy and ASCT between 1996 and 2019. Results 540 pts were enrolled in the study. The median age at diagnosis was 59 (range 29-75) years. In the first period up to 2005, induction therapy consisted mainly of conventional chemotherapies, e.g. vincristine/adriamycin/dexamethasone(VAD) (n=95). In the following years, the triple-combinations based on bortezomib coupled with anthracycline/dexamethasone (n=29), cyclophposphamide/dexamethasone (n=70) or bendamustine/prednisolone (n=169) became the most popular treatment options. After completion of induction therapy, the ORR in pts treated with VAD was only 66% with a ≥VGPR rate of 14% and ≥CR rate of 2%. The implementation of various bortezomib-containing therapy regimens significantly improved the ORR to 77-86% (p Conclusions The introduction post 2005 of modern three-drug induction regimens including bortezomib has improved the prognosis in younger MM pts undergoing first line ASCT. Our real world data in unselected pts also stress the substantial value of ASCT during the first line treatment of younger MM pts.