Long-term results of RVD treatment and risk-based maintenance therapy in newly diagnosed multiple myeloma

The study evaluated long-term outcomes of RVD involving lenalidomide (Revlimid), bortezomib (Velcade), and dexamethasone (Decadron) and risk-based maintenance therapy in patients with newly diagnosed multiple myeloma (MM). The authors found this approach to be beneficial for survival in a large group of patients.

RVD is a very effective induction therapy for patients with MM. Induction refers to the first treatment given after diagnosis. Maintenance therapy is given after induction to prevent cancer’s return. Maintenance adjusted to patients’ individual risks can be beneficial in the long-term. However, large clinical trials testing RVD and risk-based maintenance in the long-term are lacking.

The study analyzed medical records of 1000 patients with newly diagnosed MM. All patients received RVD induction between 2007 and 2016. Induction was given for 3.9 months on average. The average follow-up period was 67 months.

Overall, 97.1% of patients responded to RVD induction. Progression-free survival (PFS) refers to how long patients survive without cancer’s return or relapse. The average PFS of all patients was 65 months. Overall, patients survived for 126.6 months after therapy. The average overall survival (OS) was 78.2 months for high-risk (HR) patients. Standard-risk (SR) patients were still alive during analysis.

751 patients underwent transplantation after induction. 98.5% of patients responded after transplantation. 71% of them achieved a complete response (CR; the disappearance of all cancerous signs and symptoms) after 100 days. 

Overall, 753 patients received maintenance. 60.7% of them were SR and received lenalidomide. 10.7% received immunotherapy and drugs inhibiting protein destruction. The average PFS for patients who received maintenance therapy was 65.45 months. This was compared to 47.02 months for those who did not receive maintenance. The average overall survival for patients on maintenance therapy was 129.84 months compared to 81.15 months for the no-maintenance group.

The study concluded that RVD induction followed by risk-based maintenance therapy improved long-term treatment outcomes and survival in patients with newly diagnosed MM.

This is the largest study on RVD’s long term outcomes so far. However, it looked back in time to analyze data. Its results should be carefully considered for clinical applications.