Abstract
Bortezomib significantly improved response rates in the treatment of patients with multiple myeloma (MM). However, the process of selecting an optimal bortezomib based regimen as the initial therapy of MM remains ambiguous due to a lack of modern clinical trials demonstrating the efficacy of various bortezomib based treatments. Here, we report four bortezomib-based regimens for treatment of MM patients from three hematological treatment centers in China. MethodsNewly diagnosed MM patients in three hematological centers in China between February 1, 2006 and May 31, 2013 were treated with combination therapies including bortezomib plus dexamethasone (PD), or triple combinations of PD with adriamycin (PAD), cyclophosphamide (PCD), and thalidomide (PTD) every 28 days. ResultsThe overall response rate (≥ partial response, ORR) of all the 215 eligible patients was 90.2%. The ORR for PCD, PAD, PTD and PD were 97.4%, 93.2%, 85.3% and 77.8% respectively, while the effects with VGPR or better were 63.7%, 62.7%, 44.2% and 37.8% respectively. The effect of ORR, VGPR and CR/nCR for PCD regimen was significantly better than PD scheme (P = 0.009, 0.011, 0.005 ). The median PFS of all the patients was 29.0 months with significant differences observed between groups (P =0.047). The median OS of all the patients was not reached, but triple combinations of PD with adriamycin (PAD), cyclophosphamide (PCD), and thalidomide (PTD) were more efficient in treatment of MM patients compared to PD (P =0.005). The frequently observed toxicities were neutropenia, thrombocytopenia, fatigue, infection, herpes zoster, and peripheral neuropathy. Incidence of peripheral neuropathy (PN) in PTD group was significantly higher than other three groups, especially grade 2-3 PN. Treatment with anti-viral agent acyclovir significantly reduced the incidence of herpes zoster. ConclusionsOur study demonstrated that bortezomib-based regimens were active and well-tolerated in the Chinese MM patients, and triple combinations of PD with adriamycin (PAD), cyclophosphamide (PCD), and thalidomide (PTD) were more efficient for treatment of MM patient, and the patients received PCD or PAD demonstrated significant higher ORR compared to PD. Disclosures:No relevant conflicts of interest to declare.
Highlights
Bortezomib has significantly improved multiple myeloma (MM) response rates, but strategies for choosing bortezomib-based regimens for initial MM therapy are not standardized
Patient Characteristics Two hundred and fifteen patients with MM were eligible for inclusion in this retrospective analysis, including a total of 135 male patients and 80 female patients, and the male-to-female ratio was 1.7:1
The median Progressionfree survival (PFS) was 27.0 months for patients who received PDT, and 23.0 months for those in the plus dexamethasone (PD) group and median PFS for PCD and PD with either adriamycin (PAD) groups were not reached
Summary
Bortezomib has significantly improved multiple myeloma (MM) response rates, but strategies for choosing bortezomib-based regimens for initial MM therapy are not standardized. Clinical studies suggest that bortezomib is effective for the treatment of MM and offers improved remission and better survival [3,4,5,6,7]. At present there are bortezomib based combination chemotherapy with 2 or 3 drugs, but there is no clear strategy for choosing a regimen for different patients since few clinical trials are supported. We retrospectively analyzed the efficacy and adverse effects experienced by MM patients who received combination therapy based on bortezomib as the first-line therapy from three hematological centers in China and we report our findings here
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