硼替佐米联合地塞米松及沙利度胺治疗多发性骨髓瘤临床观察

目的:观察硼替佐米联合地塞米松及沙利度胺治疗多发性骨髓瘤的疗效与安全性。方法:回顾性总结16例接受硼替佐米联合地塞米松及沙利度胺方案治疗的多发性骨髓瘤患者的临床资料,并与接受传统化疗方案治疗的25例多发性骨髓瘤患者进行对比。结果:硼替佐米方案治疗组患者的完全缓解(CR)率是37.50%(6/16),非常好的部分缓解(VGPR)率6.25%(1/16),部分缓解(PR)率56.25%(9/16),总有效率100%;传统化疗方案治疗组CR率是16.00%(4/25),VGPR率8.00%(2/25),PR率48.00%(12/25),总有效率72.00%;硼替佐米治疗组和传统方案治疗组患者达到CR或VGPR的中位疗程数分别是2和6个(P<0.05),中位疗效持续时间分别是8和4个月;截至随访结束时,两组患者的总体生存率分别是68.75%(11/16)和68.00%(17/25)。2组治疗的主要不良反应是感染、乏力、血小板减少和肢体麻木等,但可以耐受。结论:硼替佐米联合地塞米松及沙利度胺方案治疗多发性骨髓瘤安全有效,且起效较快,值得在临床中推广应用并进一步观察其临床疗效。     

硼替佐米和沙利度胺为主的化疗方案对伴有肾功能不全的多发性骨髓瘤患者的疗效比较

目的:观察以硼替佐米为主和沙利度胺为主的化疗方案治疗伴有肾功能不全的多发性骨髓瘤(MM)患者的疗效,探讨对伴有肾功能不全的MM治疗的最佳方案.方法:40例伴有肾功能不全的MM患者,其中初治20例,复发(难治)20例.选择20例使用以硼替佐米为主的化疗方案作为试验组,以同期20例接受沙利度胺为基础的联合化疗方案治疗的MM...     

改良的以硼替佐米为基础的化疗方案治疗老年复发/难治性多发性骨髓瘤的疗效

目的探讨改良的以硼替佐米为基础的化疗方案(P-CTD方案)对老年复发/难治性多发性骨髓瘤的治疗效果。方法选择44例老年复发/难治性多发性骨髓瘤患者,21例患者接受CTD方案治疗(环磷酰胺、沙利度胺、地塞米松),23例患者接受P-CTD方案(硼替佐米、环磷酰胺、沙利度胺、地塞米松)进行治疗。上述患者共接受4个疗程的治疗,治疗结束后参照国际骨髓瘤工作组(IMWG)制定的多发性骨髓瘤疗效判定标准评估疗效,WHO标准判断不良反应。结果 CTD组患者接受治疗后,完全缓解(CR)和很好的部分缓解(VGPR)3例(14.3%),部分缓解(PR)8例(38.1%),病情稳定(SD)4例(19%),病情进展(PD)6例(28.6%),总有效(CR+VGPR+PR)11例(52.4%)。P-CTD组患者治疗后CR和VGPR 8例(34.8%),PR 11例(47.8%),SD 1例(4.3%),PD 3例(13%),总有效19例(82.6%),P-CTD组缓解率优于CTD组(P<0.05)。两组患者各种不良反应相似(P>0.05)。结论 CTD方案和P-CTD方案均具有良好的安全性,P-CTD方案的缓解率优于CTD方案。     

硼替佐米的累计剂量对多发性骨髓瘤患者生存的影响

目的:探讨硼替佐米的累计剂量对多发性骨髓瘤(MM)患者生存期的影响。方法:回顾172例MM患者的临床特点、实验室检查及治疗方法。以硼替佐米的中位累计剂量21mg/m~2为临界值,将172例MM患者根据中位累计剂量分为A组(21mg/m~2,86例)和B组(≥21mg/m~2,86例),对2组患者的基本资料采用t检验(连续变量)和χ~2检验(分类变量)进行校检,并对2组采用Kaplan-Meier生存曲线进行生存分析,Log-rank检验作单因素分析。172例MM患者中,使用含硼替佐米化疗方案的患者有83例,以硼替佐米的累计剂量21mg/m~2为临界值,将患者分为C组(21mg/m~2)和D组(≥21mg/m~2);使用含硼替佐米化疗方案联合其他化疗方案的患者有89例,以硼替佐米的累计剂量21mg/m~2为临界值,将患者分为E组(21mg/m~2)和F组(≥21mg/m~2),对C、D两组以及E、F两组采用Kaplan-Meier生存曲线进行生存分析,Log-rank检验作单因素分析。结果:172例MM患者中,B组患者的中位生存期明显高于A组(73.53个月∶18.90个月,P0.01);83例使用包含硼替佐米化疗方案的患者中,D组患者的中位生存期明显高于C组(60+个月∶17.67个月,P0.01);89例使用包含硼替佐米化疗方案联合其他治疗的患者中,F组患者的中位生存期明显高于E组(57.13个月∶26.67个月,P0.01)。与硼替佐米累计剂量低的患者相比,硼替佐米累计剂量较高的患者的严重不良反应发生率未增加。结论:提高硼替佐米的累计剂量能延长MM患者的生存期,而且未增加严重不良反应的发生率。     

硼替佐米及沙利度胺联合治疗对新发骨髓瘤患者肾功能的影响

目的 观察大剂量地塞米松为基础的常规化疗和加用硼替佐米及沙利度胺治疗后对新发骨髓瘤患者伴肾功能衰竭的影响.方法 将41例新发伴肾功能衰竭的骨髓瘤患者分为两组,均应用大剂量地塞米松为基础的化疗方案.常规化疗组(n=27)患者接受VAD(长春新碱、阿霉素、地塞米松)或VAD类似方案;新药组(n=14)在大剂量地塞米松治疗基础上加用硼替佐米和(或)沙利度胺治疗,比较两组患者在用药前后肾功能损害的改善情况.结果 常规化疗组对初治骨髓瘤肾功能不全的肾功能好转率为48.1％,中位缓解时间为1.8个月,新药组的肾功能好转率85.7％,中位缓解时间为1.4个月,使肾功能更快获得缓解.结论 大剂量地塞米松为基础的化疗方案对新发骨髓瘤患者的肾功能衰竭逆转率高,加用沙利度胺和硼替佐米治疗骨髓瘤患者可使肾功能更快好转,对骨髓瘤的治疗反应好于常规化疗组.     

硼替佐米为主治疗多发性骨髓瘤的疗效与安全性临床观察

目的:研究以硼替佐米为主的联合化疗对多发性骨髓瘤(MM)的疗效及其不良反应。方法:回顾性分析52例MM患者,其中42例接受以硼替佐米为主的联合化疗方案:初发MM 31例,复发难治MM 11例;轻链型12例,非轻链型30例;肾功能正常27例,肾功能损害15例;另外10例接受传统型(含长春新碱+蒽环类+地塞米松)化疗方案。比较硼替佐米初治组与传统化疗组,硼替佐米治疗组中轻链型与非轻链型、肾功功能正常者与肾功能损害者的疗效。同时观察42例硼替佐米治疗患者的不良反应。结果:硼替佐米初治组总有效率(ORR)和完全缓解(CR)+非常好的部分缓解(VGPR)率分别为87.10%(27/31)和64.52%(20/31),分别优于传统化疗组的20.00%(2/10)和10.00%(1/10),2组比较均差异有统计学意义(均P0.05)。硼替佐米治疗组中非轻链型患者的ORR和CR+VGPR率分别为76.67%(23/30)和56.67%(17/30),分别高于轻链型患者的75.00%(9/12)和50.00%(6/12),但2组比较差异无统计学意义;肾功能正常患者的ORR和CR+VGPR率分别为77.78%(21/27)和59.26%(16/27),分别高于肾功能损害者的73.33(11/15)和46.67%(7/15),但2组比较差异亦无统计学意义。接受硼替佐米治疗的42例患者中,不良反应主要为乏力(28.57%、12/42)和周围神经炎(35.71%、15/42)。在给药途径方面,硼替佐米静脉给药组乏力和周围神经炎的发生率,均分别高于硼替佐米皮下注射组(42.86%∶14.28%,52.38%∶19.05%,均P0.05)。结论:以硼替佐米为主的方案治疗初发MM疗效优于传统化疗方案,肾功能不全患者可以安全使用。硼替佐米的主要不良反应为乏力和周围神经炎,不良反应可以耐受。硼替佐米皮下注射给药可以有效减少不良反应,安全性相对较高。     

硼替佐米及沙利度胺联合VAD方案治疗难治复发性多发性骨髓瘤疗效观察

目的:观察硼替佐米、沙利度胺联合VAD方案治疗难治复发性多发性骨髓瘤(MM)的临床疗效和不良反应。方法:9例难治复发性MM患者均采用硼替佐米、沙利度胺联合VAD方案治疗。其中,长春新碱0.4mg/d,d1～4;阿霉素10mg/d,d1～4;地塞米松40mg/次,d1～4,d9～12,d17～20;硼替佐米2mg/d,d1,4,8,11;沙利度胺,起始量100mg/d,根据患者情况,逐渐加量至200mg/d,每晚顿服,治疗2个周期。观察疗效,并按WHO不良反应分级标准判断不良反应。结果:9例患者,3例完全缓解/接近完全缓解(CR/nCR),4例部分缓解(PR),1例进步,1例无效,CR加PR率达77.8%,总有效率88.9%。不良反应主要有乏力、便秘、皮疹、胃肠道反应及末梢神经炎,均可耐受。结论:硼替佐米、沙利度胺联合VAD方案治疗难治复发性MM近期疗效显著,耐受性好,是一种新的治疗选择。     

加强微小残留病灶检测在多发性骨髓瘤中的应用意义研究

正多发性骨髓瘤(multiple myeloma,MM)发生率居血液系统肿瘤第2位,至今仍为无法治愈的恶性肿瘤。近年来新药的不断出现,包括免疫调节药物(沙利度胺、来那度胺或泊马度胺)和蛋白酶体抑制剂(硼替佐米或卡非佐米)及合并大剂量化疗的自体干细胞移植,MM治疗的完全缓解(complete remission,CR)率不断提高,从传统化疗药物治疗的CR率约5%,到目前的50%以上,显著改善了     

硼替佐米联合化疗及自体移植治疗原发性浆细胞白血病2例并文献复习

目的:探讨硼替佐米序贯自体外周血干细胞移植治疗原发性浆细胞白血病的疗效。方法:报道2例经硼替佐米治疗达到完全缓解(CR)或非常好的部分缓解(VGPR),顺利进行自体外周血干细胞移植的原发性浆细胞白血病病例并复习相关文献。结果:硼替佐米对原发浆细胞白血病疗效显著,不影响干细胞动员与采集,联合自体周血干细胞移植,可有效提高患者生活质量。结论:硼替佐米联合化疗及自体移植可能会改善原发性浆细胞白血病的预后。     

不同剂量硼替佐米治疗多发性骨髓瘤的临床研究

目的:观察1.6mg/m2和1.3mg/m2两种剂量硼替佐米联合沙利度胺、地塞米松治疗多发性骨髓瘤患者的疗效和毒副反应。方法:快速静脉给予1.6mg/m2或1.3mg/m2 2种不同剂量的硼替佐米,同期应用沙利度胺和地塞米松。采用2006年国际骨髓瘤工作组制定的标准判定疗效,并按NCI CTCAE标准判断不良反应。结果:①剂量为1.6mg/m2的9例患者中,3例达到完全缓解(CR),CR率为33%;1.3mg/m2组25例患者中,8例达到CR,CR率为32%,2组差异无统计学意义(P>0.05);②2个疗程后早期评价疗效,1.6mg/m2组的总有效率(ORR)为87.5%,1.3mg/m2组ORR为43.5%,两组差异具有统计学意义(P<0.05);③2组主要不良反应多为胃肠道症状、周围神经病变、血小板减少,1.6mg/m2组发生率依次为66.7%、55%和33%,1.3mg/m2组发生率依次64%、56%和28%,两组差异无统计学意义(P>0.05)。结论:硼替佐米联合沙利度胺、地塞米松治疗多发性骨髓瘤临床疗效明显,不良反应轻微,1.6mg/m2硼替佐米组患者的症状改善明显,且起效快于1.3mg/m2组,患...     

Treatment with bortezomib‐based regimens improves overall response and predicts for survival in patients with primary or secondary plasma cell leukemia: Analysis of the Greek myeloma study group

Plasma cell leukemia (PCL) is a rare and aggressive plasma cell disorder, with poor outcome. Bortezomib‐based regimens (BBR) are highly effective in myeloma, but there is limited information about their efficacy and safety in PCL. Thus, we retrospectively collected data from 42 consecutive PCL patients (25 with primary PCL‐pPCL and 17 with secondary PCL‐sPCL) to explore the role of BBR in this entity. BBR were administered in 29 of 42 patients, while 6 of 25 patients with pPCL underwent autologous transplantation. Objective response (≥partial response) was significantly higher in patients treated with BBR versus conventional therapies (69% vs. 30.8%, P = 0.04); 27.5% of patients treated with BBR achieved at least very good partial response (vgPR). The highest ORR was observed in pPCL patients treated with BBR (88.9%; ≥vgPR: 33.3%). In BBR‐group, grade 3 of 4 hematological, neurological and renal toxicity and neutropenic infections were observed in 41.4%, 7%, 3.4%, and 31%, respectively. With a median follow‐up of 51 months, median overall survival (OS) for patients treated with BBR versus conventional therapies was 13 versus 2 months (P < 0.007). Median OS of patients with pPCL and sPCL treated with BBR was 18 and 7 months, respectively (P < 0.001). In the multivariate analysis normal PLTs, treatment with BBR and high quality response were the only powerful predictors for survival. Our study carrying the longest reported median follow‐up, demonstrated that treatment of PCL with BBR induces high response rates and prolongs survival over conventional therapies, regardless of additional autologous transplantation rescue or established high risk features, with manageable toxicity. Am. J. Hematol. 89:145–150, 2014. © 2013 Wiley Periodicals, Inc.     

Clinico-Pathological Spectrum of Primary Plasma Cell Leukemia Diagnosed at a Tertiary Care Centre in South India Over 5?Year Period

Plasma cell leukemia (PCL) represents a rare and aggressive form of plasma cell dyscrasia which can be primary (pPCL) or secondary (sPCL). It is diagnosed based on absolute plasma cell count of more than 2.0 × 10⁹/l or a relative proportion of greater than 20% of the peripheral blood leukocyte count. Although pPCL and sPCL share several clinical features, important differences exist. Patients with pPCL are younger; often have extra osseous organ involvement (liver, spleen and other extramedullary sites), increased frequency of renal failure, fast declining performance status and rapid progression to the terminal stage. Patients with sPCL have advanced bone disease. Presented in this article is India data of a short series of five cases of PCL diagnosed at a tertiary care centre from south India over last 5 years. All cases were de novo and had varied spectrum of presentation and so were not suspected to be plasma cell dyscrasia clinically. Detailed hemato-pathological evaluation clinched the diagnosis in all the cases.     

Phase II study of sorafenib in patients with relapsed or refractory lymphoma

The safety and activity of the multikinase inhibitor sorafenib were investigated in patients with relapsed or refractory lymphoproliferative disorders who received sorafenib (400 mg) twice daily until disease progression or appearance of significant clinical toxicity. The primary endpoint was overall response rate (ORR). Biomarkers of sorafenib activity were analysed at baseline and during treatment. Thirty patients (median age, 61 years; range, 18-74) received a median of 4 months of therapy. Grade 3-4 toxicities included hand/foot skin reactions (20%), infections (12%), neutropenia (20%) and thrombocytopenia (14%). Two patients achieved complete remission (CR), and two achieved partial remission (PR) for an ORR of 13%. Stable disease (SD) and progressive disease (PD) was observed in 15 (50%) and 11 patients (37%), respectively. The median overall survival (OS) for all patients was 16 months. For patients who achieved CR, PR and SD, the median time to progression and OS was 5 and 24 months, respectively. Compared with patients with PD, responsive patients had significantly higher baseline levels of extracellular signal-regulated kinase phosphorylation and autophagy and presented a significant reduction of these parameters after 1 month of therapy. Sorafenib was well tolerated and had a clinical activity that warrants development of combination regimens.     

Simple variables predict survival after autologous transplantation: a single centre experience in 181 multiple myeloma patients

Autologous stem cell transplantation (ASCT) has an important role in the treatment of multiple myeloma (MM) patients. The aim of our study was to analyse retrospectively the impact of selected simple parameters on the survival of patients with MM after ASCT, including age, type of M-protein, stage of MM, treatment response, and presence of renal impairment. A total of 181 MM patients were transplanted in our centre between 1995 and 2004. The median follow-up from transplant was 59 months. Following ASCT, 29% of patients were in complete remission (CR) and 62% in partial remission (PR); 35% of patients had very good partial response (VGPR). Median time to progression (TTP) and overall survival (OS) from start of therapy were 33.0 and 78.3 months, respectively. Significant prognostic parameters for poor survival after ASCT were: age at transplant > 60 years (P < 0.001), TTP < 20 months (P < 0.001), IgA type of monoclonal immunoglobulin (P = 0.045), renal impairment with serum creatinine > 177 micromol/l (> 2 mg/dl; P = 0.004), clinical stage III according to ISS (P = 0.002) and no achievement of CR and/or VGPR after ASCT (P < 0.001). The stage of the disease before ASCT did not significantly affect OS after ASCT.     

Flexible Low-Intensity Combination Chemotherapy for Elderly Patients with Acute Myeloid Leukemia

Twenty-five patients aged 57 to 88 years (median, 70 years) with acute myeloid leukemia were treated with a flexible low-intensity treatment regimen comprising mitozantrone (mitoxantrone) 6 mg/m2 administered by intravenous infusion x3 days, cytarabine 10 mg/m2 subcutaneously every 12 hours x7 to 14 days, and etoposide 100 mg orally x7 to 14 days. Seventeen of these patients had a preexisting myelodysplastic syndrome. The clinical response was correlated to the results of cytogenetic studies (23 patients) and of viability studies of leukemic blasts (7 patients). Eleven of the 25 patients achieved complete remission (CR), 8 achieved partial remission (PR), and 4 showed no response. There was 1 toxic death, and 1 patient died soon (1 week) after presentation. Treatment was well tolerated. Although myelotoxicity occurred regularly, the recovery time was < or = 3 weeks for most of the responding patients. Duration of survival for patients who had CR has ranged from 4+ to 43+ months and for patients who had PR, 3 to 16 months. Irrespective of the remission status (CR or PR), responding patients with favorable (n = 1) or intermediate (n = 10) cytogenetic findings had a significantly better survival time (median, 14 months) than did those with unfavorable (n = 7) cytogenetic findings (median, 5 months). In vitro studies showed a progressive reduction in the number of circulating blasts. The number of viable blasts 3 days after initiation of therapy appeared to give an early indication of clinical response. Treatment with a flexible low-intensity protocol seems to achieve results comparable with those reported for intensive antileukemia therapy and has much less toxicity.     

Short progression-free survival predicts for poor overall survival in older patients with multiple myeloma treated upfront with novel agent-based therapy

Objectives: To assess the importance of the quality of response and of early relapse in unselected elderly patients with myeloma treated upfront with novel agents. Methods: We analyzed 135 unselected transplant‐ineligible patients older than 65 yr who were treated upfront with novel agent‐based regimens in a single center. Results: On intent to treat, 81% of patients achieved a response (28% sCR/CR, 23% VGPR, and 30% PR). Median progression‐free survival (PFS) for patients who achieved sCR/CR was 31 vs. 20 months for VGPR and 23 months for PR (P = 0.048). Median overall survival (OS) for patients with sCR/CR was 62 months, 53 months for VGPR and 38 months for patients with PR (P = 0.028). Early relapse (PFS < 12 months) was more common in patients with PR (39% vs. 21% for VGPR vs. 3% for sCR/CR). Patients who relapsed or progressed <12 months from initiation of treatment had a median OS of 15.4 months compared with 53 months (P < 0.001) for patients who had a PFS > 12 months despite the fact that after relapse or progression most patients were treated again with novel agents. In multivariate analysis, short PFS was the most significant adverse prognostic factor affecting OS, associated with a 7.25‐fold (P < 0.0001) increase in the risk of death. Conclusion: In newly diagnosed patients over 65 yr, treated upfront with novel agents achievement of CR and a PFS ≥12 months is associated with improved outcome. Patients who fail to respond or experience early relapse after primary therapy with novel agent‐based regimens should be encouraged to participate in clinical trials of novel agents and combinations.     

The relationship between quality of response and clinical benefit for patients treated on the bortezomib arm of the international, randomized, phase 3 APEX trial in relapsed multiple myeloma

Quality of response is associated with prolonged overall survival (OS) in newly diagnosed multiple myeloma patients. This cohort study within the phase 3 Assessment of Proteasome Inhibition for Extending Remissions (APEX) trial of bortezomib versus dexamethasone in relapsed myeloma assessed the relationship between quality of response to bortezomib (n = 315) and clinical benefit. Treatment-free interval (TFI), time to alternative therapy (TTAT), time to progression (TTP) and OS were assessed in response-evaluable patients in the bortezomib arm in cohorts defined by achievement of complete response (CR; n = 27), very good partial response (VGPR; n = 31), partial response (PR; n = 77), minimal response (MR; n = 21) or non-response (NR, including stable and progressive disease; n = 159). CR was associated with significantly longer median TFI (24.1 vs. 6.9/6.4 months) and TTAT (27.1 vs. 13.6/14 months) versus VGPR/PR. Median TTP was similar in CR, VGPR and PR cohorts; median OS was not reached. Patients achieving MR appeared to have prolonged median TFI (3.8 vs. 2.3 months), TTAT (8.7 vs. 6.2 months), TTP (4.9 vs. 2.8 months) and OS (24.9 vs. 18.7 months) versus NR. In conclusion, bortezomib had substantial activity in relapsed myeloma patients; CR may be a surrogate marker for significant clinical benefit with bortezomib. MR appeared to be valid as a separate response category in this setting.     

Long-term prognostic significance of response in multiple myeloma after stem cell transplantation

For establishing the true effect of different response categories in patients with multiple myeloma (MM) treated with autologous stem cell transplantation, we evaluated, after a median follow-up of 153 months, 344 patients with MM who received a transplant between 1989 and 1998. Overall survival (OS) at 12 years was 35% in complete response (CR) patients, 22% in near complete response (nCR), 16% in very good partial response (VGPR), and 16% in partial response (PR) groups. Significant differences in OS and progression-free survival were found between CR and nCR groups (P = .01 and P = .002, respectively), between CR and VGPR groups (P = .0001 and P = .003), or between CR and PR groups (P = .003 and P = < 10(-5)); no differences were observed between the nCR and VGPR groups (P = .2 and P = .9) or between these groups and the PR group (P = .1 and P = .8). A landmark study found a plateau phase in OS after 11 years; 35% patients in the CR group and 11% in the nCR+VGPR+PR group are alive at 17 years; 2 cases had relapsed in the nCR+VGPR+PR group. In conclusion, MM achieving CR after autologous stem cell transplantation is a central prognostic factor. The relapse rate is low in patients with > 11 years of follow-up, possibly signifying a cure for patients in CR.     

Bortezomib plus dexamethasone for relapsed or treatment refractory multiple myeloma: the collaborative study at six institutes in Kyoto and Osaka

We conducted a retrospective collaborative investigation of bortezomib (Bor) plus dexamethasone (Dex) therapy (BD Tx) for 88 relapsed or refractory (Rel/Ref) MM patients at six institutes. One cycle BD Tx comprised of Bor (1.3 mg/m2/day) on days 1, 4, 8 and 11, and Dex on days 1, 2, 4, 5, 8, 9, 11 and 12, every 21 days, and the mean number of BD Tx cycles was 3. The overall response rate was 66.9%, the median overall survival (OS) was 510 days, and the median progression-free survival (PFS) was 113 days. Attainment of partial response (PR) with the first course of BD Tx associated with the longer OS and PFS and late good responder, while no patient who did not achieve PR with the first cycle attained better than very good PR (VGPR) with the subsequent BD Tx. Patient age of less than 64 years old also associated with the longer OS and PFS. In addition, both an earlier disease stage and Dex dosage had a significant impact on OS, while the attainment of VGPR within 2 cycles had a significantly longer PFS. Earlier BD Tx courses may be predictive for the subsequent therapeutic pathway of Rel/Ref MM.     

Autologous stem cell transplantation in first remission is associated with better progression-free survival in multiple myeloma

Autologous stem cell transplant (ASCT) is standard consolidation therapy in management of multiple myeloma (MM) patients. We reviewed records of all consecutive MM patients who underwent ASCT with high-dose melphalan at our center from year 2002 to 2016. A total of 141 ASCT were conducted (90 males and 51 females) with median age of 55 years (23–68 years). Median time from diagnosis to transplant was 7 months (3–79), with majority of patients underwent transplant in first remission, while 17 (12%) patients received transplant beyond first remission. Eighty-three percent patients obtained CR/VGPR post-ASCT. Transplant-related mortality was 2.1%. At a median follow up of 54 months, mean overall survival (OS) and progression-free survival (PFS) group were 128.3 months (95% C.I. 111.9–144.7 months) and 73.8 months (95% C.I. 57.7–89.9 months), respectively. On univariate analysis, OS was adversely affected by renal insufficiency (p?=?0.024), while OS was better with CR/VGPR post-ASCT (p?<?0.001) and lenalidomide maintenance therapy (p?=?0.009). PFS was affected by CR/VGPR pre-ASCT (p?=?0.021), CR/VGPR post-ASCT (p?<?0.001), and transplant in first remission (p?=?0.034). On multivariate analysis, lenalidomide maintenance (versus thalidomide) (p?=?0.007) and CR/VGPR response post-ASCT (p?=?0.0003) were found to be predictors for better OS and CR/VGPR response at transplant for better PFS (p?=?0.038). Transplant in first remission versus beyond first remission showed a trend for better PFS (p?=?0.073). Conclusion: Majority of patients obtained CR/VGPR post-ASCT. Longer PFS was seen with patients who were transplanted in first remission.