P-174: Clinical study of bortezomib-based regimens of BCD, PAD and VDD for newly diagnosed multiple myeloma – an analysis of 400 cases in a single center of China

Abstract

<h3>Background</h3> Objective To investigate the clinical efficacy and safety of bortezomib-based regimens of BCD (bortezomib, cyclophosphamide and dexamethasone), PAD (bortezomib, doxorubicin and dexamethasone) and VDD (bortezomib, pegylated liposomal doxorubicin and dexamethasone). <h3>Methods</h3> 400 newly diagnosed multiple myeloma (MM) patients enrolled in two prospective non-randomized cohort studies in a single center were retrospectively analyzed from April 2008 to August 2017. <h3>Results</h3> Among all the patients, 194 cases (48.5%) received BCD, 84 cases (21.0%) received PAD, and 122 cases (30.5%) received VDD. 1) Analysis of clinical features: Serum albumin (ALB) level was lower in the BCD group than the other two (P<0.001), and the proportion of patients in the International Stage System (ISS) stage III was higher in the BCD and VDD groups than the PAD group (P=0.002). Patients younger than 65 years were much more in the PAD group than the other two. Correspondingly, the proportion of patients receiving autologous hematopoietic stem cell transplantation (ASCT) was significantly higher in the PAD group. 2) The overall response rates (ORR) of the patients in BCD, PAD and VDD groups were 87.5%, 83.6% and 83.0% respectively, and there was no significant difference between the three groups. More patients attained complete response (CR) in the VDD group than the other two (P=0.049).The rate of minimal residual disease (MRD) negativity was slightly higher (60%) in PAD group which may be related to the higher ASCT proportion in this group, but the difference was not statistically significant (P=0.272). 3) Whether combined with alkylating agents (BCD) or combined with anthracyclines (PAD and VDD), there was no significant difference of the median progression-free survival (PFS) and the median overall survival (OS). Also there was no significant difference in PFS and OS between BCD, PAD and VDD groups. 4) In the safety aspect, there was no significant difference in non-hematologic toxicities such as peripheral neuropathies, cardiac events, gastrointestinal reactions, thrombus and bleeding events between the three groups. The incidence of hand-foot syndrome in VDD group was 5.8%, all of which were grade 1/2. In terms of hematologic toxicity, the incidence of grade 3/4 neutropenia and thrombocytopenia was significantly higher in the PAD group than the other two groups. There was no significant difference between the BCD and VDD group. <h3>Conclusion</h3> As the bortezomib-based three-drug regimens combined with traditional chemotherapeutic agents, BCD, PAD and VDD can all achieve remission in more than 80% newly diagnosed MM patients as induction therapy. The efficacy and long-term outcomes are comparable between the three regimens. In the aspects of safety, the BCD and VDD groups had a lower risk of grade 3/4 hematological toxicity.