Evaluating outcomes in patients with multiple myeloma after RVD therapy followed by stem cell transplant outside of clinical trials

This study assessed the safety and effectiveness of RVD (lenalidomide, bortezomib, dexamethasone) in patients with multiple myeloma before a stem cell transplant (SCT) in a real-life setting (outside of clinical trials). This study concluded that this treatment was safe and effective for these patients.

Multiple myeloma (MM) is a type of cancer of the bone marrow that can lead to abnormal immune cells. Autologous SCT remains a standard treatment for MM. In autologous SCT, high-dose chemotherapy called a conditioning regimen is given first to get rid of any remaining cancer cells. Then, healthy stem cells are collected from the patient’s bloodstream. During the transplant, these healthy cells are then reintroduced back to the patient.

The RVD regimen has shown promising effectiveness in clinical trials for patients with MM. Survival outcomes are even better when RVD is combined with autologous SCT. However, patients are very carefully selected for clinical trials. Their outcomes may not be the same in real-life practice. The outcomes of patients treated with RVD plus autologous SCT in real-life clinical practice are unclear.

This study had 40 patients with MM. All patients received 3 to 4 cycles of RVD as a first-line treatment. Then, patients were given high-dose melphalan (Alkeran) chemotherapy (conditioning). Then, patients underwent autologous SCT. After the transplant, 30 patients received lenalidomide (Revlimid) maintenance therapy to help prevent cancer from coming back. Patients were followed-up for an average of 47 months.

After the transplant, 95% of patients had no signs of cancer. At the end of treatment, 22.5% of patients had zero residual disease (cancer cells left after treatment). These patients survived significantly longer without disease progression (tumor growth or spread).

Overall, patients survived for an average of 76 months. Patients survived for an average of 45 months without disease progression (tumor growth or spread). At follow-up, 50% of patients were still alive without cancer coming back.

Overall, 65% of all patients experienced side effects. Most side effects were mild. The most common ones were numbness or tingling in the hands or feet (52.5%), low white blood cell count (25%), and low platelet count (cells involved in blood clotting; 17.5%).

20% of patients had serious side effects. The most common one was a low white blood cell count (5 patients). Low platelet count, numbness or tingling in the hands or feet, and respiratory tract infections were reported in 2 patients each. 5% of patients stopped treatment due to serious side effects.

This study concluded that the RVD combination followed by SCT was safe and effective for patients with multiple myeloma.

This study was retrospective, meaning that it looked back in time to analyze data. This study also had a small number of patients. Larger studies are needed to confirm these results.