Long-term follow-up after bortezomib, thalidomide, and dexamethasone treatment followed by double stem cell transplant in patients with multiple myeloma.

This study compared long-term outcomes after treatment with bortezomib (Velcade), thalidomide (Thalomid), and dexamethasone (Ozurdex) or VTD compared to thalidomide and dexamethasone (TD) followed by double hematopoietic stem cell transplant (HSCT) in patients with newly diagnosed multiple myeloma (MM). The study found that the addition of bortezomib gave the best patient outcome after 10 years.

MM is a type of blood cancer. Treatment options for MM include a double autologous HSCT. For HSCT, healthy stem cells are taken from the patient. These stem cells are used to replace those destroyed by radiotherapy (RT) or chemotherapy (CT). An HSCT is usually followed up with more therapy to ensure all the cancer cells have been destroyed. This is called consolidation therapy.

The VTD and TD regimens can be used to treat patients before and after HSCT. Studies have been done to compare the VTD regimen with the TD regimen. The VTD regimen increased patients’ rate of survival without disease worsening. However, there have not been any long-term evaluations of VTD. The impact that the VTD regimen could have on overall patient survival is not yet clear.

This study included 474 patients with newly diagnosed MM. All patients had double HSCT at 3-6 months apart. 236 patients were given VTD before and after HSCT. 238 patients received TD before and after HSCT. The average follow-up time was 124.1 months.

The average time without disease progression was 60 months in the VTD group compared to 41 months in the TD group. After 10 years, 34% of the VTD group were alive without disease progression. This was compared to 17% in the TD group. 

60% of the VTD group were estimated to survive compared to 46% of the TD group. Bortezomib added to TD was associated with a 40% increase in the chance of living without cancer worsening. 

6% of the VTD group and 10% of the TD group developed a second cancer. 

This study concluded that VTD treatment before and after double HSCT improved the long-term outcomes for patients with MM.

The study did not include data on the long-term side effects of VTD.