High efficacy and safety of VTD as an induction protocol in patients with newly diagnosed multiple myeloma eligible for high dose therapy and autologous stem cell transplantation: A report of the Polish Myeloma Study Group

Hus,Iwona; Mańko,Joanna; Jawniak,Dariusz; Jurczyszyn,Artur; Charliński,Grzegorz; Poniewierska‑Jasak,Katarzyna; Usnarska‑Zubkiewicz,Lidia; Sawicki,Mateusz; Druzd‑Sitek,Agnieszka; Świderska,Alina; Kopińska,Anna; Grząśko,Norbert; Raźny,Małgorzata; Wędłowska,Aleksandra; Perzyński,Aleksander; Gałązka,Aleksandra; Dytfeld,Dominik; Kubicki,Tadeusz; Rodzaj,Marek; Waszczuk‑Gajda,Anna; Drozd‑Sokołowska,Joanna; Pogłódek,Bartłomiej; Pasternak,Anna; Długosz‑Danecka,Monika; Szymczyk,Agnieszka; Dmoszyńska,Anna

doi:10.3892/ol.2019.10929

High efficacy and safety of VTD as an induction protocol in patients with newly diagnosed multiple myeloma eligible for high dose therapy and autologous stem cell transplantation: A report of the Polish Myeloma Study Group

Authors:
- Iwona Hus
- Joanna Mańko
- Dariusz Jawniak
- Artur Jurczyszyn
- Grzegorz Charliński
- Katarzyna Poniewierska‑Jasak
- Lidia Usnarska‑Zubkiewicz
- Mateusz Sawicki
- Agnieszka Druzd‑Sitek
- Alina Świderska
- Anna Kopińska
- Norbert Grząśko
- Małgorzata Raźny
- Aleksandra Wędłowska
- Aleksander Perzyński
- Aleksandra Gałązka
- Dominik Dytfeld
- Tadeusz Kubicki
- Marek Rodzaj
- Anna Waszczuk‑Gajda
- Joanna Drozd‑Sokołowska
- Bartłomiej Pogłódek
- Anna Pasternak
- Monika Długosz‑Danecka
- Agnieszka Szymczyk
- Anna Dmoszyńska
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Affiliations: Department of Clinical Transplantology, Medical University of Lublin, 20-081 Lublin, Poland, Department of Hematooncology and Bone Marrow Transplantation, Medical University of Lublin, 20-081 Lublin, Poland, Department of Hematology, Collegium Medicum, Jagiellonian University, 30‑051 Cracow, Poland, Department of Hematology, Specialist Muncipial Hospital, 87‑100 Torun, Poland, Department of Hematology, Holycross Cancer Center, 25‑734 Kielce, Poland, Department of Hematology, Blood Neoplasms and Bone Marrow Transplantation, Wroclaw Medical University, 50‑367 Wroclaw, Poland, Department of Lymphoid Malignancies, Institute of Oncology, 02‑781 Warsaw, Poland, Department of Hematology, University Hospital in Zielona Góra, 65‑046 Zielona Góra, Poland, Department of Hematology and Bone Marrow Transplantation, Medical University of Silesia, 40‑032 Katowice, Poland, Department of Hematology, St. John of Dukla Lublin Region Cancer Center, 20‑090 Lublin, Poland, Department of Hematology, Ludwik Rydygier Memorial Specialized Hospital, 31‑826 Cracow, Poland, Department of Hematology and Transplantology, Medical University of Gdansk, 80‑211 Gdansk, Poland, Department of Hematology, Institute of Hematology and Transfusion Medicine, 00‑791 Warsaw, Poland, Department of Hematology and Bone Marrow Transplantation, Poznan University of Medical Sciences, 60‑569 Poznan, Poland, Department of Hematology, Oncology and Internal Medicine, Medical University of Warsaw, 02‑097 Warsaw, Poland, Department of Oncologic Hematology, Specialist Hospital, 36‑200 Brzozów, Poland, Department of Hematology, Independent Public Health Care of Ministry of The Interior and Administration, 10‑228 Olsztyn, Poland
Published online on: September 27, 2019 https://doi.org/10.3892/ol.2019.10929
Pages: 5811-5820
Copyright: © Hus et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

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Abstract

The present retrospective analysis evaluated the efficacy and safety of the VTD (bortezomib, thalidomide, dexamethasone) regimen in 205 newly‑diagnosed patients with multiple myeloma (MM) eligible for high dose therapy and autologous stem cell transplantation (HDT/ASCT) in routine clinical practice. With a median of 6 cycles (range, 1‑8), at least partial response was achieved in 94.6% and at least very good partial response (VGPR) was achieved in 67.8% of patients. Peripheral neuropathy (PN) grade 2‑4 was observed in 28.7% of patients. In 72% of patients undergoing stem cell mobilization one apheresis allowed the number of stem cells sufficient for transplantation to be obtained. Following HDT/ASCT the sCR rate increased from 4.9 to 14.4% and CR from 27.8 to 35.6%. The results demonstrated that VTD as an induction regimen was highly efficient in transplant eligible patients with MM with increased at least VGPR rate following prolonged treatment (≥6 cycles). Therapy exhibited no negative impact on stem cell collection, neutrophils and platelets engraftment following ASCT. Therapy was generally well tolerated and PN was the most common reason of dose reduction or treatment discontinuation.

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1	Moreau P, San Miguel J, Sonneveld P, Mateos MV, Zamagni E, Avet-Loiseau H, Hajek R, Dimopoulos MA, Ludwig H, Einsele H, et al: Multiple myeloma: ESMO Clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol. 28 (Suppl 4):iv52–iv61. 2017. View Article : Google Scholar : PubMed/NCBI
2	Munshi NC, Anderson KC, Bergsagel PL, Shaughnessy J, Palumbo A, Durie B, Fonseca R, Stewart AK, Harousseau JL, Dimopoulos M, et al: Consensus recommendations for risk stratification in multiple myeloma: Report of the International Myeloma workshop consensus panel 2. Blood. 117:4696–4700. 2011. View Article : Google Scholar : PubMed/NCBI
3	Anderson KC: The 39th David A. Karnofsky Lecture: Bench-to-bedside translation of targeted therapies in multiple myeloma. J Clin Oncol. 30:445–452. 2012. View Article : Google Scholar : PubMed/NCBI
4	Palumbo A and Anderson K: Multiple myeloma. N Engl J Med. 364:1046–1060. 2011. View Article : Google Scholar : PubMed/NCBI
5	Kumar SK, Callander NS, Alsina M, Atanackovic D, Biermann JS, Chandler JC, Costello C, Faiman M, Fung HC, Gasparetto C, et al: Multiple myeloma, version 3.2017, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw. 15:230–269. 2017. View Article : Google Scholar : PubMed/NCBI
6	Mateos MV, Ocio EM, Paiva B, Rosiñol L, Martínez-López J, Bladé J, Lahuerta JJ, García-Sanz R and San Miguel JF: Treatment for patients with newly diagnosed multiple myeloma in 2015. Blood Rev. 29:387–403. 2015. View Article : Google Scholar : PubMed/NCBI
7	Rajkumar SV: Multiple myeloma: 2016 update on diagnosis, risk-stratification, and management. Am J Hematol. 91:719–734. 2016. View Article : Google Scholar : PubMed/NCBI
8	Dmoszynska A, Walter-Croneck A, Usnarska-Zubkiewicz L, Stella-Holowiecka B, Walewski J, Charliński G, Jedrzejczak W, Wiater E, Lech-Maranda E, Dytfeld D, et al: Recommendations of polish myeloma group concerning diagnosis and therapy of multiple myeloma and other plasmacytic dyscrasias for 2015. Acta Hematol Pol. 46:159–211. 2015.
9	Kyle RA and Rajkumar SV: Criteria for diagnosis, staging, risk stratification and response assessment of multiple myeloma. Leukemia. 23:3–9. 2009. View Article : Google Scholar : PubMed/NCBI
10	Greipp PR, San Miguel J, Durie BG, Crowley JJ, Barlogie B, Bladé J, Boccadoro M, Child JA, Avet-Loiseau H, Kyle RA, et al: International staging system for multiple myeloma. J Clin Oncol. 23:3412–3420. 2005. View Article : Google Scholar : PubMed/NCBI
11	Palumbo A, Avet-Loiseau H, Oliva S, Lokhorst HM, Goldschmidt H, Rosinol L, Richardson P, Caltagirone S, Lahuerta JJ, Facon T, et al: Revised international staging system for multiple myeloma: A report from international myeloma working group. J Clin Oncol. 33:2863–2869. 2015. View Article : Google Scholar : PubMed/NCBI
12	Voorhees PM and Usmani SZ: The role of high-dose melphalan and autologous stem cell transplant in the rapidly evolving era of modern multiple myeloma therapy. Clin Adv Hematol Oncol. 14:719–728. 2016.PubMed/NCBI
13	Hari P: Recent advances in understanding multiple myeloma. Hematol Oncol Stem Cell Ther. 10:267–271. 2017. View Article : Google Scholar : PubMed/NCBI
14	Cavo M, Tacchetti P, Patriarca F, Petrucci MT, Pantani L, Galli M, Di Raimondo F, Crippa C, Zamagni E, Palumbo A, et al: Bortezomib with thalidomide plus dexamethasone compared with thalidomide plus dexamethasone as induction therapy before, and consolidation therapy after, double autologous stem-cell transplantation in newly diagnosed multiple myeloma: A randomised phase 3 study. Lancet. 376:2075–2085. 2010. View Article : Google Scholar : PubMed/NCBI
15	Moreau P, Avet-Loiseau H, Facon T, Attal M, Tiab M, Hulin C, Doyen C, Garderet L, Randriamalala E, Araujo C, et al: Bortezomib plus dexamethasone versus reduced-dose bortezomib, thalidomide plus dexamethasone as induction treatment before autologous stem cell transplantation in newly diagnosed multiple myeloma. Blood. 118:5752–5758. 2011. View Article : Google Scholar : PubMed/NCBI
16	Moreau P, Hulin C, Macro M, Caillot D, Chaleteix C, Roussel M, Garderet L, Royer B, Brechignac S, Tiab M, et al: VTD is superior to VCD prior to intensive therapy in multiple myeloma: Results of the prospective IFM2013-04 trial. Blood. 127:2569–2574. 2016. View Article : Google Scholar : PubMed/NCBI
17	Durie BG, Hoering A, Abidi MH, Rajkumar SV, Epstein J, Kahanic SP, Thakuri M, Reu F, Reynolds CM, Sexton R, et al: Bortezomib with lenalidomide and dexamethasone versus lenalidomide and dexamethasone alone in patients with newly diagnosed myeloma without intent for immediate autologous stem-cell transplant (SWOG S0777): A randomised, open-label, phase 3 trial. Lancet. 389:519–527. 2017. View Article : Google Scholar : PubMed/NCBI
18	Wang A, Duan Q, Liu X, Ding K, Han Y, Zhu W, Cai X, Wu J and Sun Z: (Bortezomib plus lenalidomide/thalidomide)-vs. (bortezomib or lenalidomide/thalidomide)-containing regimens as induction therapy in newly diagnosed multiple myeloma: A meta-analysis of randomized controlled trials. Ann Hematol. 91:1779–1784. 2012. View Article : Google Scholar : PubMed/NCBI
19	Landgren O and Iskander K: Modern multiple myeloma therapy: Deep, sustained treatment response and good clinical outcomes. J Intern Med. 281:365–382. 2017. View Article : Google Scholar : PubMed/NCBI
20	Huang H, Zhou L, Peng L, Fu W, Zhang C and Hou J: Bortezomib-thalidomide-based regimens improved clinical outcomes without increasing toxicity as induction treatment for untreated multiple myeloma: A meta-analysis of phase III randomized controlled trials. Leuk Res. 38:1048–1054. 2014. View Article : Google Scholar : PubMed/NCBI
21	Ludwig H, Viterbo L, Greil R, Masszi T, Spicka I, Shpilberg O, Hajek R, Dmoszynska A, Paiva B, Vidriales MB, et al: Randomized phase II study of bortezomib, thalidomide, and dexamethasone with or without cyclophosphamide as induction therapy in previously untreated multiple myeloma. J Clin Oncol. 31:247–255. 2013. View Article : Google Scholar : PubMed/NCBI
22	Rosinol L, Oriol A, Teruel AI, Hernández D, López-Jiménez J, de la Rubia J, Granell M, Besalduch J, Palomera L, González Y, et al: Superiority of bortezomib, thalidomide, and dexamethasone (VTD) as induction pretransplantation therapy in multiple myeloma: A randomized phase 3 PETHEMA/GEM study. Blood. 120:1589–1596. 2012. View Article : Google Scholar : PubMed/NCBI
23	Cavo M, Pantani L, Pezzi A, Petrucci MT, Patriarca F, Di Raimondo F, Marzocchi G, Galli M, Montefusco V, Zamagni E, et al: Bortezomib-thalidomide-dexamethasone (VTD) is superior to bortezomib-cyclophosphamide-dexamethasone (VCD) as induction therapy prior to autologous stem cell transplantation in multiple myeloma. Leukemia. 29:2429–2431. 2015. View Article : Google Scholar : PubMed/NCBI
24	Avet-Loisseau H, Leleu X, Roussel M, Moreau P, Guerin-Charbonnel C, Caillot D, Marit G, Benboubker L, Voillat L, Mathiot C, et al: Bortezomib plus dexamethasone induction improves outcome of patients with t(4;14) myeloma but not outcome of patients with del(17p). J Clin Oncol. 28:4630–4634. 2010. View Article : Google Scholar : PubMed/NCBI
25	Mateos MV, Gutierrez NC, Martín-Ramos ML, Paiva B, Montalbán MA, Oriol A, Martínez-López J, Teruel AI, Bengoechea E, Martín A, et al: Outcome according to cytogenetic abnormalities and DNA ploidy in myeloma patients receiving short induction with weekly bortezomib followed by maintenance. Blood. 118:4547–4553. 2011. View Article : Google Scholar : PubMed/NCBI
26	Shaughnessy JD, Zhou Y, Haessler J, van Rhee F, Anaissie E, Nair B, Waheed S, Alsayed Y, Epstein J, Crowley J and Barlogie B: TP53 deletion is not an adverse feature in multiple myeloma treated with total therapy 3. Br J Haematol. 147:347–351. 2009. View Article : Google Scholar : PubMed/NCBI
27	An G, Acharya C, Deng S, Yi S, Xu Y, Qin X, Sui W, Li Z, Shi L, Zang M, et al: Cytogenetic and clinical marks for defining high-risk myeloma in the context of bortezomib treatment. Exp Hematol. 43:168–176.e2. 2015. View Article : Google Scholar : PubMed/NCBI
28	Neben K, Lokhorst HM, Jauch A, Bertsch U, Hielscher T, van der Holt B, Salwender H, Blau IW, Weisel K, Pfreundschuh M, et al: Administration of bortezomib before and after autologous stem cell transplantation improves outcome in multiple myeloma patients with deletion 17p. Blood. 119:940–948. 2012. View Article : Google Scholar : PubMed/NCBI
29	Sonneveld P, Salwender H, Van Der Holt B, El Jarari L, Bertsch U, Blau LW, Zweegman S, Weisel KC, Vellenga E, Pfreundschuh M, et al: Bortezomib induction and maintenance in patients with newly diagnosed multiple myeloma: Long-term follow-up of the HOVON-65/GMMG-HD4 trial. Blood. 126:272015.
30	Moreau P, Attal M, Pégourié B, Planche L, Hulin C, Facon T, Stoppa AM, Fuzibet JG, Grosbois B, Doyen C, et al: Achievement of VGPR to induction therapy is an important prognostic factor for longer PFS in the IFM2005-01 trial. Blood. 117:3041–3044. 2011. View Article : Google Scholar : PubMed/NCBI
31	Rajkumar SV, Jacobus S, Callander NS, Fonseca R, Vesole DH, Williams ME, Abonour R, Siegel DS, Katz M and Greipp PR; Eastern Cooperative Oncology Group, : Lenalidomide plus high-dose dexamethasone versus lenalidomide plus low-dose dexamethasone as initial therapy for newly diagnosed multiple myeloma: An open-label randomised controlled trial. Lancet Oncol. 11:29–37. 2010. View Article : Google Scholar : PubMed/NCBI
32	Richardson PG, Weller E, Lonial E, Jakubowiak AJ, Jagannath S, Raje NS, Avigan DE, Xie W, Ghobrial IM, Schlossman RL, et al: Lenalidomide, bortezomib, and dexamethasone combination therapy in patients with newly diagnosed multiple myeloma. Blood. 116:679–686. 2010. View Article : Google Scholar : PubMed/NCBI
33	Tacchetti P, Terragna C, Galli M, Zamagni E, Petrucci MT, Pezzi A, Montefusco V, Martello M, Tosi P, Baldini L, et al: Bortezomib- and thalidomide-induced peripheral neuropathy in multiple myeloma: Clinical and molecular analyses of a phase 3 study. Am J Hematol. 89:1085–1091. 2014. View Article : Google Scholar : PubMed/NCBI
34	Leiba M, Kedmi M, Duek A, Freidman T, Weiss M, Leiba R, Nagler A and Avigdor A: Bortezomib-cyclophosphamide-dexamethasone (VCD) versus bortezomib-thalidomide-dexamethasone (VTD)-based regimens as induction therapies in newly diagnosed transplant eligible patients with multiple myeloma: A meta-analysis. Br J Haematol. 166:702–710. 2014. View Article : Google Scholar : PubMed/NCBI
35	Moreau P, Pylypenko H, Grosicki S, Karamanesht I, Leleu X, Grishunina M, Rekhtman G, Masliak Z, Robak T, Shubina A, et al: Subcutaneous versus intravenous administration of bortezomib in patients with relapsed multiple myeloma: A randomised, phase 3, non-inferiority study. Lancet Oncol. 12:431–440. 2011. View Article : Google Scholar : PubMed/NCBI
36	Hus I, Walter-Croneck A, Masternak A, Jurczyszyn A, Usnarska-Zubkiewicz L, Bołkun Ł, Druzd-Sitek A, Rymko M, Łętowska J, Lech-Marańda E, et al: Real-life experience with bortezomib-based regimens in elderly patients with newly diagnosed multiple myeloma and comorbidities: A Polish retrospective multicenter study. Pol Arch Intern Med. 127:765–774. 2017.PubMed/NCBI
37	Goldschmidt H, Moreau P, Ludwig H, Niesvizky R, Chng WJ, Joshua D, Weisel K, Spencer A, Orlowski RZ, Feng S, et al: Carfilzomib-dexamethasone versus subcutaneous or intravenous bortezomib in relapsed or refractory multiple myeloma: Secondary analysis of the phase 3 ENDEAVOR study. Leuk Lymphoma. 59:1364–1374. 2018. View Article : Google Scholar : PubMed/NCBI
38	Merz M, Salwender H, Haenel M, Mai EK, Bertsch U, Kunz C, Hielscher T, Blau IW, Scheid C, Hose D, et al: Peripheral neuropathy associated with subcutaneous or intravenous bortezomib in patients with newly diagnosed myeloma treated within the GMMG MM5 phase III trial. Haematologica. 101:e485–e487. 2016. View Article : Google Scholar : PubMed/NCBI
39	Minarik J, Pavlicek P, Pour L, Pika T, Maisnar V, Spicka I, Jarkovsky J, Krejci M, Bacovsky J, Radocha J, et al: Subcutaneous bortezomib in multiple myeloma patients induces similar therapeutic response rates as intravenous application but it does not reduce the incidence of peripheral neuropathy. PLoS One. 10:e01238662015. View Article : Google Scholar : PubMed/NCBI
40	Brioli A, Perrone G, Patriarca F, Pezzi A, Nobile F, Ballerini F, Motta MR, Ronconi S, Tacchetti P, Catalano L, et al: Successful mobilization of PBSCs predicts favorable outcomes in multiple myeloma patients treated with novel agents and autologous transplantation. Bone Marrow Transplant. 50:673–678. 2015. View Article : Google Scholar : PubMed/NCBI
41	Kumar S, Dispenzieri A, Lacy MQ, Hayman SR, Buadi FK, Gastineau DA, Litzow MR, Fonseca R, Roy V, Rajkumar SV and Gertz MA: Impact of lenalidomide therapy on stem cell mobilization and engraftment post-peripheral blood stem cell transplantation in patients with newly diagnosed myeloma. Leukemia. 21:2035–2042. 2007. View Article : Google Scholar : PubMed/NCBI
42	Paripati H, Stewart AK, Cabou S, Dueck A, Zepeda VJ, Pirooz N, Ehlenbeck C, Reeder C, Slack J, Leis JF, et al: Compromised stem cell mobilization following induction therapy with lenalidomide in myeloma. Leukemia. 22:1282–1284. 2008. View Article : Google Scholar : PubMed/NCBI
43	Kumar S, Giralt S, Stadtmauer EA, Harousseau JL, Palumbo A, Bensinger W, Comenzo RL, Lentzsch S, Munshi N, Niesvizky R, et al: Mobilization in myeloma revisited: IMWG consensus perspectives on stem cell collection following initial therapy with thalidomide-, lenalidomide-, or bortezomib-containing regimens. Blood. 114:1729–1735. 2009. View Article : Google Scholar : PubMed/NCBI
44	Sinha S, Gertz MA, Lacy MQ, Dispenzieri A, Hayman SR, Buadi FK, Dingli D, Micallef IN, Hogan WJ, Gastineau DA, et al: Majority of patients receiving initial therapy with lenalidomide-based regimens can be successfully mobilized with appropriate mobilization strategies. Leukemia. 26:1119–1122. 2012. View Article : Google Scholar : PubMed/NCBI
45	Giebel S, Sadus-Wojciechowska M, Halaburda K, Drozd-Sokolowska J, Wierzbowska A, Najda J, Mendrek W, Sobczyk-Kruszelnicka M, Nowicki M, Holowiecki J and Czerw T: Increased efficacy of intermediate-dose cytarabine + G-CSF compared to DHAP + G-CSF for stem cell mobilization in patients with lymphoma: An analysis by the polish lymphoma research group. Ann Hematol. 95:263–269. 2016. View Article : Google Scholar : PubMed/NCBI
46	Harousseau JL, Attal M and Avet-Loiseau H: The role of complete response in multiple myeloma. Blood. 114:3139–3146. 2009. View Article : Google Scholar : PubMed/NCBI
47	Child JA, Morgan GJ, Davies FE, Owen RG, Bell SE, Hawkins K, Brown J, Drayson MT and Selby PJ; Medical Research Council Adult Leukaemia Working Party, : High-dose chemotherapy with hematopoietic stem cell rescue for multiple myeloma. N Engl J Med. 348:1875–1883. 2003. View Article : Google Scholar : PubMed/NCBI
48	Wang M, Delasalle K, Feng L, Thomas S, Giralt S, Qazilbash M, Handy B, Lee JJ and Alexanian R: CR represents an early index of potential long survival in multiple myeloma. Bone Marrow Transplant. 45:498–504. 2010. View Article : Google Scholar : PubMed/NCBI
49	Chanan-Kahn A and Giralt S: Importance of achieving a complete response in multiple myeloma, and the impact of novel agents. J Clin Oncol. 28:2612–2624. 2010. View Article : Google Scholar : PubMed/NCBI
50	Attal M, Harousseau JL, Facon T, Guilhot F, Doyen C, Fuzibet JG, Monconduit M, Hulin C, Caillot D, Bouabdallah R, et al: Single versus double autologous stem-cell transplantation for multiple myeloma. N Engl J Med. 349:2495–2502. 2003. View Article : Google Scholar : PubMed/NCBI
51	Cavo M, Tosi P, Zamagni E, Cellini C, Tacchetti P, Patriarca F, Di Raimondo F, Volpe E, Ronconi S, Cangini D, et al: Prospective, randomized study of single compared with double autologous stem-cell transplantation for multiple myeloma: Bologna 96 clinical study. J Clin Oncol. 25:2434–2441. 2007. View Article : Google Scholar : PubMed/NCBI
52	Benyamini N, Avivi I, Dann EJ, Zuckerman T, Lavi N and Katz T: Comparison of engraftment following different stem cell mobilization modalities in patients with multiple myeloma treated with a uniform induction regimen containing bortezomib, cyclophosphamide and dexamethasone. Ann Hematol. 96:461–467. 2017. View Article : Google Scholar : PubMed/NCBI
53	Blimark CH, Turesson I, Genall A, Ahlberg L, Björkstrand B, Carlson K, Forsberg K, Juliusson G, Linder O, Mellqvist UH, et al: Outcome and survival of myeloma patients diagnosed 2008–2015. Real-world data on 4904 patients from the Swedish Myeloma Registry. Haematologica. 103:506–513. 2018. View Article : Google Scholar : PubMed/NCBI