Evaluating the effectiveness and safety of different regimens of containing pegylated liposomal doxorubicin in patients with newly diagnosed multiple myeloma.

This study investigated the effectiveness and safety of different regimens containing pegylated liposomal doxorubicin (PLD; Doxil) for patients with newly diagnosed multiple myeloma (NDMM). The data showed that the different PLD treatment regimens had promising effectiveness with manageable side effects.

Multiple myeloma (MM) is a type of cancer that comes from blood cells called plasma cells. A high number of patients with MM experience relapse (the tumor grows after treatment) or are refractory (not responsive) to standard treatment. Currently, the treatment strategies for relapsed/refractory (r/r) MM are based on the different combinations of conventional drugs and novel drugs. 

PLD is a chemotherapy drug that has been approved in combination with bortezomib (Velcade) for the treatment of r/r MM. However, the effectiveness and safety of PLD in different regimens for patients with NDMM have not been fully studied.

This study involved 249 patients with NDMM. 112 patients received vindesine (Eldisine)-based chemotherapy and 137 patients received bortezomib-based chemotherapy. In the vindesine group, 35 patients received vDD (PLD + vindesine + dexamethasone) and 77 patients received vAD (epirubicin + vindesine + dexamethasone). In the bortezomib group, 58 patients received VDD (PLD + bortezomib + dexamethasone), and 79 patients received VD (bortezomib + dexamethasone). The average follow-up period for the vindesine-based group was 25 months and 16 months for the bortezomib-based group.

In the vindesine-based group, the overall response rate (ORR; the partial or complete disappearance of the cancer) was 65.7% for vDD and 63.6% for vAD. 

In the bortezomib-based group, the ORR was 91.4% with VDD and 84.8% with VD. Overall, 48.3% of the patients in the VDD subgroup achieved a complete response compared to 30.4% of the patients in the VD subgroup. 74.1% of the patients in the VDD subgroup achieved a very good partial response compared to 57% of the patients in the VD subgroup. There was no difference in survival rates between the VDD and the VD subgroup or between the vDD and the vAD subgroups.

The most common side-effects like low platelet counts, low white blood cell counts, anemia, pneumonia, and urinary tract infection. These side effects were more common in the VDD group compared to the VD group. Infections occurred more commonly in the vDD group compared to the vAD group. The occurrence rates of all heart-related side effects were similar between the VDD and VD subgroups.

This study concluded that the effectiveness of vindesine-based regimens was similar with or without PLD in patients with NDMM. However, the addition of PLD to bortezomib-based regimens led to better responses with manageable side effects.

This study looked back in time at medical records. The study was conducted at a single institution in China. The follow-up time was very short to fully evaluate the benefits of PLD in patients with NDMM.