Effectiveness of VCD-VTD therapy for older patients with newly diagnosed multiple myeloma.

This study assessed the effects of administering personalized doses of VCD (bortezomib, cyclophosphamide, and dexamethasone) followed by VTD (bortezomib, thalidomide, and dexamethasone) in older patients with newly diagnosed multiple myeloma (NDMM). The data showed high response rates and safety in these patients.

NDMM often occurs in patients above 65 years of age. Due to this, many patients are frail because of other medical conditions. The Vulnerable Elders Survey-13 (VES-13) is an assessment tool used in older patients with MM to evaluate for risk of complications and health deterioration.

A main treatment for MM is stem cell transplant. However, patients that are transplant-ineligible can be managed using standard combination treatments. However, these treatments were based on clinical trials that usually did not include frail, older patients with MM.

Alternative treatments with VCD followed by VTD have led to improved patient responses and prolonged survival. VCD has been shown to be safer and less toxic than VTD for older patients. Further investigations are needed for a more effective, personalized approach using VCD and VTD in these patients.

This study included 47 patients with NDMM that were transplant-ineligible. Frailty was assessed for all patients using the VES-13. Based on these scores, 16 patients were assigned to a Fit group (VES-13 score 0-2) and 31 patients to a Frail group (VES-13 score 3-10).

Patients in the Fit group had 4 cycles of standard-dose VCD, then 4 cycles of standard-dose VTD. Patients in the Frail group had 4 cycles of reduced-dose VCD, then 4 cycles of reduced-dose VTD. The average follow-up time was 37 months.

The overall response rate was 87.5% for the Fit group and 87.1% for the Frail group. The 3-year survival without cancer worsening rate was 68.8% for the Fit group and 53.3% for the Frail group. The 3-year overall survival rate was 70% for the Fit group and 77.6% for the Frail group.

The study suggested that appropriately tailored doses of sequential VCD and VTD therapies had high response rates and safety in older patients with MM.

This study had a small number of participants. Larger studies are needed.