Bortezomib, cyclophosphamide and dexamethasone as induction therapy in multiple myeloma

This paper studied the effectiveness of bortezomib (Velcade), cyclophosphamide (Cytoxan) and dexamethasone in patients with multiple myeloma who had not been previously treated. The combination of bortezomib, cyclophosphamide and dexamethasone was found to be effective and well-tolerated. 

Multiple myeloma is a cancer of the plasma cells of the bone marrow. High-dose chemotherapy plus autologous (from the patient) stem-cell transplantation is the standard treatment for younger, previously untreated patients. Before stem-cell transplantation, patients receive induction therapy to reduce the tumor size. In multiple myeloma, a better response after induction therapy has been shown to improve overall outcomes. Studies have found that a combination of bortezomib, cyclophosphamide and dexamethasone is effective in patients with relapsed or refractory (not responding to treatment) myeloma. Initial studies have also found it to be an effective regimen for induction therapy in multiple myeloma. 

395 patients aged 18–60 years with previously untreated multiple myeloma were studied. After induction therapy, patients were offered stem-cell transplantation. 89.4% of patients completed three cycles of induction therapy with bortezomib, cyclophosphamide and dexamethasone. Reasons for stopping treatment included side effects, death and worsening disease.

The overall response rate was 85.4%. There was no significant difference in overall response rate between patients with and those without genetic abnormalities.

112 patients were followed after they received stem-cell transplantation. Among these patients, the overall response rate was 95.5%. At an average follow-up period of 55.5 months, the average duration of survival without worsening disease was 35.3 months.

Adverse events (undesired effect of treatment) occurred in 99.2% of patients receiving treatment. The most common adverse events were low white cell count (53.4%) and low platelet (cells involved in clotting) levels (32.7%). 3.8% of patients had pneumonia. 39% of patients had an adverse event related to nerve injury. Six patients died while receiving induction therapy. 3 of the deaths were considered as possibly related to the induction therapy. 

The authors concluded that bortezomib, cyclophosphamide and dexamethasone as induction therapy for previously untreated multiple myeloma was effective, even in those with genetic abnormalities. 

Talk to your doctor about receiving bortezomib, cyclophosphamide and dexamethasone as induction therapy before stem-cell transplantation.