Bortezomib plus intermediate‐dose dexamethasone and thalidomide in elderly untreated patients with multiple myeloma: A Chinese experience

Abstract

Bortezomib has proven to be active in patients with multiple myeloma (MM), including elderly patients. The aim of this study was to evaluate the efficacy and toxicity of bortezomib in combination with intermediate‐dose dexamethasone (Dex) and thalidomide in untreated MM patients aged ≥65 years in a Chinese single center. In this study, 18 patients were treated with bortezomib at 1.3 mg/m2 IV on Days 1, 4, 8, and 11 and Dex at 20 mg/day IV on Days 1–4 and 8–11 simultaneously. Thalidomide at dose of 100 mg/day was given everyday. The mean number of cycles of bortezomib treatment was 2.06. Three patients (17%) achieved a complete response (CR), four (22%) a very good partial response (VGPR), and nine (50%) a PR, resulting in an overall response rate of 89%. The median time to response was 22 days (range 14–50 days). The duration of response was significantly longer in patients achieving a CR/VGPR with respect to those achieving only a PR (8.5 vs. 4.2 months, P = 0.03). Grade 3–4 toxicities occurring in patients comprised weakness, thrombocytopenia, diarrhea, infection, and neuropathy. Only one patient suffered from deep vein thrombosis. This preliminary experience in Chinese patients indicated that bortezomib‐Dex‐thalidomide is highly effective in elderly untreated patients with MM, even in patients with poor prognostic features. Am. J. Hematol. 2010. © 2010 Wiley‐Liss, Inc.

Real-World Clinical Outcomes in Elderly Chinese Patients with Multiple Myeloma: A Single-Center Experience

“…As expected, in the present study, first-line therapy with short-course bortezomib-based regimens significantly improved the overall response rate (ORR) and ≥ very good partial response (VGPR) when compared with non-bortezomib regimens [16], but the high ORR and VGPR rate were not reflected in the survival advantage in elderly NDMM patients (data not shown). However, patients treated with short-course bortezomib-based regimens during their course of disease had a significantly longer OS than those treated without it.…”

Feasibility and efficacy of administration of bortezomib‐containing regimens to patients over the age of 70 years

“…However, the combined response rate (complete response + partial response) in this cohort was 40%. By comparison, in our elderly cohort, with a higher minimum age, the combined response rate was 81% (control cohort: 83%), similar to more recent reports (Guo et al , 2010). Given that there is now accumulating evidence that depth of response is of prognostic significance, this difference would be expected to have an impact on survival (Harousseau et al , 2010).…”

Treatment and prognostic factors for survival in newly diagnosed multiple myeloma patients with bortezomib and dexamethasone regimen: a single Chinese center retrospective study

“…For the published studies analyzing prognostic factors of survival of Chinese MM patients, our results were not so consistent with them. 12 – 14 , 17 In the study by Lu et al, 12 sex, ISS stage, number of FISH abnormalities and extramedullary disease were the prognostic factors for survival, and no prognostic factors were observed by Guo et al 14 More interestingly, theoretically high levels of albumin should be correlated with better outcome, but opposite results were found in this study. The potential explanation for the discrepancies might be because of the different groups of patients and centers in People’s Republic of China.…”

“… 2 Although overwhelming number of studies all over the world have investigated the role of bortezomib in MM in vivo and in vitro, very few studies from People’s Republic of China have summarized the effect, tolerability and prognostic factors of bortezomib for newly diagnosed MM up to date. 12 – 14 Although in recent years more new agents such as next generation of proteasome inhibitors (eg, carfilzomib) and immunomodulatory drugs (eg, pomalidomide) have been used in clinical trials and approved by the FDA, 6 , 15 , 16 they are currently not available in the Chinese market. As a result, chemotherapy regimens including bortezomib are still the standardized treatment for MM in People’s Republic of China.…”