Therapie

ASCT

  • Patient < 70 ohne Komorbiditäten die eine Kontraindikation darstellen
  • Patient 70 - 75 ohne Komorbitiäten und einem Fragility Score von FIT
  • keine Dosisreduktion von Melphalan bei fiten Pat. 70-75

ASCT wann?

  • Response nach Initialtherapie (PAD,VDT,VCD):
  • keine ASCT bei Progression nach Initialtherapie

 

  • Melphalan 200mg/m2 am Tag - 2

Dosisanpassung bei Niereninsuffizienz:
Kreatinin-Clearance >40 ml/min               100%
Kreatinin-Clearance 40 ml/min                 50%

Therapie nach ASCT?

Response     

  • Observans
  • bei Hochrisikopatienten Tandemtransplantation
  • in Studien Konsolidierung
  • in Studien Erhaltung

Response

  • Tandemtransplantation
  • alternativ - Konsolidierung
  • alternativ - Erhaltung

Konsolidierung:

      • Consolidation treatment is generally short-term and aims to improve responses after ASCT. Upgraded rates of CR and CR-nCR, in the range between 10% and 30%, have been recently reported with post-ASCT use of bortezomib or lenalidomide as single agents or with VTD. In several of these studies, consolidation therapy with VTD yielded molecular remissions in up to 60% of patients.

Erhaltung:

      • Two independent randomized trials have recently shown a significantly
        longer PFS for patients randomized to lenalidomide maintenance
        (5-15 mg/day) compared with the placebo group after a single or double ASCT.

 

Einige Schlussfolgerung aus Studien zur ASCT:

  • early autotransplantation was associated with a longer event-free survival (EFS) and better quality of life.
  • failed to show superior OS with double ASCT which, by the opposite, was associated with improved response rates and EFS.
    In 2 studies of double ASCT, post-hoc subgroup analyses showed that the second autotransplantation improved clinical outcomes in those patients who failed high-quality responses after the first ASCT. the IMWG suggests considering timely second ASCT in those patients who fail to achieve a very good partial response (VGPR) or better after the first ASCT.
  • Attainment of CR after both induction therapy and ASCT is one of the strongest predictors of long-term outcomes and represents a major endpoint of current treatment strategies incorporating autotransplantation up-front.