In a nutshell
This study compared two induction therapy regimens before high-dose chemotherapy and stem cell (immature blood cell) transplantation (SCT) in patients with multiple myeloma. The authors concluded that the combination of bortezomib (Velcade), thalidomide (Thalomid), and dexamethasone (Ozurdex) was more effective than bortezomib, cyclophosphamide (Cytoxan), and dexamethasone.
Some background
The standard treatment for patients under the age of 66 with multiple myeloma is induction therapy to induce remission, followed by high-dose chemotherapy and SCT. Prior studies have shown that bortezomib-based induction is very effective. One standard option is now bortezomib combined with a treatment that stimulates the immune system (thalidomide) and the steroid dexamethasone (VTD). Another option is bortezomib and dexamethasone combined with the chemotherapy cyclophosphamide (VCD). It is not clear which combination is more effective.
Methods & findings
This study included 340 patients who were randomly assigned to induction therapy with VTD (170 patients) or VCD (170 patients). Patients were treated for at least 4 cycles.
After 4 cycles, 66.3% of VTD patients achieved at least a very good partial response (little or no sign of disease), compared to 56.2% of VCD patients. There was no significant difference in the rate of complete response (no sign of disease). 92.3% of VTD patients responded to treatment, compared to 83.4% of VCD patients.
Patients treated with VCD had higher rates of low red blood cell, white blood cell, and platelet levels. The risk of peripheral neuropathy (tingling and pain in the hands or feet) was higher with VTD.
The bottom line
This study concluded that VTD therapy may be more effective than VCD before high-dose chemotherapy and SCT.
Published By :
Blood
Date :
May 26, 2016
