Upfront bortezomib, lenalidomide, and dexamethasone compared to bortezomib, cyclophosphamide, and dexamethasone in multiple myeloma

Abstract

Objectives At our center, patients with multiple myeloma (MM) were treated upfront with bortezomib, cyclophosphamide, and dexamethasone (VCD) until cyclophosphamide was replaced with lenalidomide in the combination (VRD). These treatments have never been compared head‐to‐head in large real‐life patient material. Method A retrospective analysis of patients treated with VRD and VCD in the first line, both with and without subsequent high‐dose treatment (HDT) and autologous stem cell transplantation. A total of 681 patients were included, 117 receiving VRD (71 with, 46 without HDT) and 564 receiving VCD (351 with, 213 without HDT). Results Overall response rate (≥partial response) was higher with VRD compared to VCD in the entire VRD group (98% vs 88%, P < 0.001) and in the non‐HDT group (98% vs 79%, P < 0.001). Progression‐free survival (PFS) at 18 months was longer with VRD compared to VCD in the entire VRD group, the non‐HDT group and the HDT group (88% vs 63%, 82% vs 32% and 91% vs 73%, respectively). Overall survival at 18 months was better for VRD‐treated patients in the entire VRD group (95% vs 89%, P = 0.048). Conclusion Upfront VRD gives better responses and longer PFS compared to VCD in MM patients with or without subsequent HDT.

Efficacy and tolerability of VCD chemotherapy in a UK real‐world dataset of elderly transplant‐ineligible newly diagnosed myeloma patients

“…A recently published retrospective study which included 213 NDMM patients treated with VCD and did not later receive high dose therapy and ASCT, demonstrated an 18‐month PFS rate of 32% 14 …”

Improved survival in multiple Myeloma patients undergoing autologous stem cell transplantation is entirely in the standard cytogenetic risk groups

“…Of the 715 patients, 375 were evaluated for add1q21, del17p21, t(4; 14), and t(14;16). Data for age, sex, and type of MM, as well as, laboratory measurements, were collected as earlier described by our group 7‐10 . The number of patients receiving ASCT increased with time because MM care has been concentrated to only one center in Stockholm during the last two decades.…”

“…As earlier described, the induction treatment consisted of the combination of vincristine, doxorubicin, and dexamethasone (VAD) in period I, vincristine at a dose of 1.6 mg/m 2 , and doxorubicin at a dose of 36 mg/m 2 , was given as a continuous infusion on days 1‐4 together with dexamethasone at a dose of 20 mg per day on days 1‐4, 9‐12, and 17‐20 and was repeated every 4 weeks, the median number of cycles were 3, 3‐5 VAD, or cyclophosphamide combined with betamethasone (CyBet) in period II, cyclophosphamide 1000 mg/m 2 intravenously on day 1, and betamethasone 15 mg/day orally on days 1, 2, 4, 5, 8, 9, 11, and 12, the median number of cycles were 3 3‐5 . In period III, PIs and IMiDs were introduced to induction treatment; bortezomib, cyclophosphamide, and dexamethasone (VCD) 9 or bortezomib, lenalidomide, and dexamethasone (VRD) were used at our center 10 . VCD was given in 3‐week cycles with bortezomib 1.3 mg/m 2 sc on days 1, 4, 8, and 11; cyclophosphamide 1000 mg/m 2 IV on day 1, and dexamethasone 20 mg per day orally on days 1, 2, 4, 5, 8, 9, 11, and 12.…”

Lenalidomide, Bortezomib, and Dexamethasone as Induction Therapy Before Autologous Stem Cell Transplant for Multiple Myeloma

“…Additionally, 4 [17][18][19][20] non-randomized studies and 5 [21][22][23][24][25] guidelines (captured in 6 reports [21][22][23][24][25][26] ) were identified, and are described in the following subsections. Two relevant reports for were available for the National Comprehensive Cancer Network (NCCN) guidelines: the main guidelines 22 and the NCCN Evidence Blocks TM .…”