P-182: Comparison of lenalidomide, bortezomib, dexamethasone vs bortezomib, cyclophosphamide, dexamethasone as an induction regimen in newly diagnosed myeloma patients eligible for intensive chemotherapy

Abstract

<h3>Background</h3> Induction with lenalidomide, bortezomib and dexamethasone (VRD) is a standard of care for newly diagnosed multiple myeloma patients (NDMM). However, lenalidomide might be difficult to manage, for example if acute kidney failure or thromboembolic events are present at diagnosis. In these cases, induction with bortezomib, cyclophosphamide and dexamethasone (VCD), might be more easily manageable. We conducted a retrospective study to assess efficacy of VCD and VRD as induction regimens, in NDMM, eligible for intensive treatment, treated between 2010 and 2020. Overall, 110 patients were treated, 62 received VCD and 48 VRD. Median age was 64 (range, 36-72) years in the VCD group and 59 (33-71) in the VRD group. There was no difference in ISS stage III status [VCD n=21 (34%) vs VRD n=17 (35%), p=.5470], although there were more high-risk cytogenetics patients in the VRD group [VCD n=4 (7%) vs VRD n=10 (16%), p=.248]. Patients received a median number of 4 (3-9) cycles of VCD and 4 (3-8) cycles of VRD. Of note, in the VCD group, 5 (8%) patients switched to VRD, mostly because of renal function improvement. All patients completed the induction phase and underwent high dose melphalan (HDM) at 200 mg/m2: VCD, n=24 and VRD, n=40; or 140 mg/m2: VCD, n=37 and VRD, n=8, and autologous stem cell transplant (ACST). After ACST, 45 (63%) and 32 (67%) patients received consolidation treatment; 9 patients in the VCD group received VRD as consolidation. Among the 5 patients who switched from VCD to VRD, 1 also received VRD consolidation, 1 received RD without bortezomib, and 3 did not received consolidation. Then, 20 (32%) and 34 (71%) received maintenance with lenalidomide in the VCD and VRD group, respectively. Median follow-up was 3.75 years. Overall response rate (ORR) was similar in the two groups, whatever the time point: 98 vs 98% ORR was seen before HDM and ACST, 100 vs 98% after 3 months, 92 vs 93% after 6 months and 73 vs 73% after 1 year, for VCD and VRD groups, respectively. However, faster and deeper responses were achieved with VRD compared to VCD, with VGPR or more achieved in 79 vs 60% patients before ACST, 90 vs 77% after 3 months, 85 vs 77% after 6 months and 73 vs 65% after 1 year, respectively. There were no significant differences in survival data between groups. Progression-free survival was 3.2 years in the VCD group and 4.75 years in the VRD group (p=ns). Overall survival was not reached in the VCD group and 8.9 years in the VRD group (p=ns). <h3>Conclusion</h3> VRD yielded faster and deeper responses compared to VCD in our series, but this did not translate into significant differences of PFS nor OS. Even if VRD remains the standard induction regimen today for NDMM eligible for ACST, VCD remains a good alternative to VRD, with similar ORR and no significant differences in survival. We believe that these data are relevant and useful for clinicians who deal with multiple myeloma patients in daily practice. Multivariate analysis will be updated for IMW congress.