Successful treatment of patients with newly diagnosed/untreated light chain multiple myeloma with a combination of bendamustine, prednisone and bortezomib (BPV)

Abstract

The median number of the BPV cycles was 2 (1-5). 24 patients (96%) responded with 4 stringent complete responses, 6 near-complete responses, 5 very good partial responses and 9 partial responses. The myeloma light chains decreased rapidly, reaching the best response after the first cycle in 9 and after the second cycle in additional 12 patients. 17 patients discontinued therapy after median 2 cycles of BPV treatment to receive autologous or allogeneic SCT. All together 12 of 18 patients with at least moderate renal failure improved their renal function. 3 of the 6 dialysis-dependent patients became dialysis-independent. With a median follow-up of 27 months, median progression-free survival and overall survival for patients at 30 months were 68 and 96%, respectively. The most common severe side effect was grade 3/4 leukocytopenia in 20% of the patients. Grade 3/4 thrombocytopenia was observed in 12% of the patients. Moderate to severe infection were seen in six patients. We conclude that BPV is effective and well tolerated in patients with newly diagnosed/untreated light chain multiple myeloma.

Prognostic impact of rapid reduction of involved free light chains in multiple myeloma patients under first-line treatment with Bendamustine, Prednisone, and Bortezomib (BPV)

“…Accordingly, a significant decrease of iFLC/sFLCr after two cycles was shown to be a prognostic factor for ORR (Hassoun et al 2005) and OS (Dispenzieri et al 2008;Yağcı et al 2015) in conventional chemotherapy studies. In contrast, bortezomib containing therapies lead to a more rapid reduction of sFLC (van Rhee et al 2007;Tessenow et al 2017). In the present study, 45% of the patients treated with BPV reached a ≥ 50% reduction of the iFLC by day 8.…”

An Overview of Light Chain Multiple Myeloma: Clinical Characteristics and Rarities, Management Strategies, and Disease Monitoring

“…The most common severe side effects were grade III-IV leukopenia in 22.2% patients and grade III-IV thrombocytopenia in 13.3% patients. Moderate to severe infection was seen in 22.2% patients (Table 2 ) [ 21 - 22 ].…”

“…In the study by Mrachacz et al (2015) and Tessenow et al (2017) patients treated with a combination of bortezomib, bendamustine (B), and prednisone (P) showed an ORR of > 95% (Table 2 ) [ 21 - 22 ]. However, better PFS was seen, when bortezomib was used in combination with bendamustine compared to dexamethasone (95% vs. 25% at two years).…”

Carfilzomib, bendamustine, and dexamethasone in patients with advanced multiple myeloma: The EMN09 phase 1/2 study of the European Myeloma Network

“…In vitro, a combination of PI and chemotherapy creates synergistic effects 8,10 . A phase 3 study in patients with untreated MM established the superiority of bendamustine to melphalan, 7 and bendamustine‐bortezomib combinations were efficacious and well tolerated in this setting, including patients who had renal impairment 14,20 . However, because many patients already had received bortezomib during front‐line therapy, 11,13 increased PN was an issue.…”

“…MM established the superiority of bendamustine to melphalan, 7 and bendamustine-bortezomib combinations were efficacious and well tolerated in this setting, including patients who had renal impairment. 14,20 However, because many patients already had received bortezomib during front-line therapy, 11,13 increased PN was an issue. With effective supportive therapy available, 21,22 a reasonable quality of life is achievable even in patients with Cancer September 15, 2021 advanced MM.…”