Modified Bortezomib, Lenalidomide, Dexamethasone Induction Regimen Efficacious, Tolerable for Transplant-Eligible Patients With Newly Diagnosed Multiple Myeloma

A recent study demonstrated the efficacy and tolerability of a modified induction protocol for patients with newly diagnosed multiple myeloma (NDMM) who are eligible for autologous stem cell transplantation (ASCT). Results were published in the European Journal of Haematology.

According to the study authors, induction with therapy combining bortezomib, lenalidomide, and dexamethasone (VRd) shows high efficacy but with limited tolerability in some patients. This retrospective study was an evaluation of the efficacy and tolerability of a modified VRd-based induction regimen, VRD lite, that was used at 4-week intervals in transplant-eligible patients (N=48) with NDMM.

In the VRD lite regimen used in this study, subcutaneous bortezomib dosed at 1.3 mg/m² was given on days 1, 8, 15, and 22 of each cycle. Dexamethasone (40 mg) was administered on the days that bortezomib was given. Oral lenalidomide was given at a dosage of 15 mg on days when bortezomib was not given (days 2-7, 9-14, and 16-21).

The authors reported an overall response rate (ORR) of 83%, with a very good partial response (VGPR) or better rate of 48%. Patients who completed 4 or more cycles of VRd lite had an ORR of 87% and a VGPR or better rate of 50%.

Of 38 patients who received 4 or more cycles of VRd lite and underwent ASCT, the ORR was reportedly 100%, with a VGPR or better rate of 74%.

Lymphocytopenia was reported in 46% of patients, with neutropenia in 31%. Liver dysfunction and peripheral neuropathy each occurred in 27%. Grade 3 neutropenia occurred in 19% of patients, and grade 4 neutropenia occurred in 6%. Dose modifications were reported in 15.2% of patients in this study.

“In this retrospective analysis, VRd lite demonstrated high efficacy with better tolerability in transplant-eligible patients with NDMM,” the study authors wrote in their report.

Reference

Okazuka K, Ishida T, Nashimoto J, et al. The efficacy and safety of modified bortezomib-lenalidomide-dexamethasone in transplant-eligible patients with newly diagnosed multiple myeloma [published online November 16, 2019]. Eur J Haematol. doi: 10.1111/ejh.13349