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Vincent Rajkumar, MD

Vincent Rajkumar, MD. Mayo Clinic Rochester, MN. Induction Therapy: Thal/Dex in Newly Diagnosed MM. Mayo Clinic Study: 50 Patients 64% response rate MDACC Study: 40 Patients 72% response rate ECOG: Thal/Dex vs Dex: 58% vs 42%.

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Vincent Rajkumar, MD

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  1. Vincent Rajkumar, MD Mayo Clinic Rochester, MN

  2. Induction Therapy: Thal/Dex in Newly Diagnosed MM • Mayo Clinic Study: 50 Patients64% response rate • MDACC Study: 40 Patients72% response rate • ECOG: Thal/Dex vs Dex: 58% vs 42% Rajkumar SV. J Clin Oncol. 2002; 20:4319-4323Weber D. J Clin Oncol. 2003; 21:16-19Rajkumar SV. ASH 2004; Abstract 205

  3. Results with Stem Cell Transplantation 1.00 100 p=0.03 by Wilcoxon test p=0.04 by log-rank test Highdose 0.75 54 75 Intensivetherapy 42 0.50 50 Overall survival (%) Survival Standard therapy Conventional dose 0.25 25 0.00 0 0 20 40 60 80 0 15 30 45 60 Month Month Attal M. N Engl J Med. 1996; 335:97 Child J. N Engl J Med. 2003; 348:1875

  4. Early vs. Delayed Transplant Auto BMT (n=258) – 58 months VBMCP (n=252) – 53 months Allo (n=42) – 13 months 1.0 Early HDT Late HDT 100 0.9 0.8 80 0.7 0.6 60 P (survival) 0.5 % 0.4 40 0.3 0.2 20 0.1 0.0 0 0 10 20 30 40 50 60 70 80 90 100 0 24 48 72 96 120 Months Months Fermand. Blood. 1998; 92:3131 Barlogie B. ASH 2003; Abstract 135

  5. Advantages of Early Transplant • Better quality of life • Evaluation of tandem transplant • Evaluation of trials investigating maintenance therapy • Insurance issues

  6. High-Risk MM • Deletion 13 or hypodiploidy • PCLI >3% • Molecular Genetics: t(4;14), t(14;16), 17p- Rajkumar SV. Best Pract Res Clin Haem. 2005;18:585-601

  7. 0 12 24 36 48 60 72 84 96 108 120 1.0 0.9 0.8 0.7 0.6 0.5 0.4 0.3 0.2 0.1 0.0 Presence of Hypodiploidy or Deletion 13 and Survival Risk group Median OS Normal (n=984) 51 monthsOther Abn. Karyotypes (n=236) 36 monthsHypodiploidy/del 13 (n=255) 19 months Probability of Event-Free Survival P<0.001 Months From First Transplant Fassas A. Br J Haem. 2002; 118:1041-1047

  8. Approach to Newly Diagnosed Myeloma Low Risk High Risk Not a Transplant Candidate Transplant Candidate • Novel Rx • Novel Agents • Auto-Mini-Allo • Routine Maintenance MP or MPT or MPR/MPV/ Rev-Dex on trial Rev-Dex on trial or Dex or Thal-Dex x 4 Stem Cell Harvest for 2 Transplants Tx1; Tx2 for pts not in CR/VGPR Continue induction at lower dosesorConventional chemo; Tx at relapse Rajkumar SV. Mayo Clin Proc. 2005; 80:1371-1382

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