In a nutshell
This study examined if intensive chemotherapy after initial chemotherapy made treatment more effective for patients with multiple myeloma (MM). The authors concluded that intensive chemotherapy increased survival without tumor growth or spread for these patients.
In MM, cancer cells become different from one another as the disease progresses. Some cancer cells become resistant to treatment. For this reason, treatment may involve combinations of chemotherapy drugs rather than one drug alone. However, some patients do not respond well to this initial treatment. For these patients, intensifying further treatment may help improve outcomes.
CVD (cyclophosphamide, bortezomib, dexamethasone) is an intensive chemotherapy regimen. The goal of intensive chemotherapy is to improve the results of initial treatment. Whether CVD chemotherapy improves outcomes for patients with MM who do not respond well to initial treatment is unclear.
Methods & findings
This study had 583 patients with MM who did not fully respond to initial treatment. 289 patients received an average of 4 cycles of CVD chemotherapy. 294 patients did not receive CVD. Patients were followed for an average of 27.3 to 29.7 months.
After CVD, 42.6% (123 patients) had very good tumor shrinkage or better. Of these, 3.5% (10 patients) had no signs of cancer after CVD. 39.1% (113 patients) had tumor shrinkage.
77.3% (CVD) and 78.5% (no-CVD) of patients were still alive 3 years later. On average, patients in the CVD group survived for significantly longer without the cancer progressing compared to the no-CVD group (30 months vs. 20 months). CVD treatment lowered the risk of tumor growth or spread by 40%.
After treatment, 367 patients were eligible for a stem cell transplant (SCT). After the transplant, more patients in the CVD group had no signs of cancer compared to patients in the no-CVD group (14.3% vs. 5.9%).
Most side effects were mild. In the CVD group, the most common side effects were low red blood cell count (73%) and numbness or tingling in the hands or feet (60%). Low platelet count (cells involved in blood clotting; 47%) and low white blood cell count (27%) were also reported.
The bottom line
This study concluded that intensive CVD chemotherapy increased survival without tumor growth or spread for patients with MM. The authors suggest that this regimen may improve outcomes for patients who go on to have SCT.
The fine print
This study did not have a placebo group, which may bias these results. The standard of care for MM has changed since this study ended, so the results may not accurately reflect the effectiveness of current treatments.
Talk to your care team about the potential benefits of intensive chemotherapy during treatment.
Published By :
The Lancet. Haematology
Oct 14, 2019
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