Sequential therapy of four cycles of bortezomib, melphalan, and prednisolone followed by continuous lenalidomide and dexamethasone for transplant-ineligible newly diagnosed multiple myeloma

Abstract The combinations of melphalan, bortezomib, and prednisolone (VMP) and of lenalidomide and dexamethasone (Rd) are standard treatment strategies for transplant-ineligible newly diagnosed multiple myeloma (NDMM). To make the most of these two strategies, we investigated the efficacy and feasibility of first-line treatment with 4 cycles of VMP followed by continuous Rd therapy in a multi-institutional phase 2 study in Japanese patients with transplant-ineligible NDMM. Thirty-six patients of median age 74 years old with NDMM initially received 35-day cycles of VMP: oral melphalan (6 mg/$ m^{2} $) and prednisolone (60 mg/$ m^{2} $) on days 1 to 4 and bortezomib (1.3 mg/$ m^{2} $) on days 1, 8, 15, and 22. After 4 cycles of VMP, treatment was switched to 28-day cycles of Rd, which was continued until disease progression or emergence of an unacceptable adverse event (AE) in 33 patients, while one patient who achieved CR after VMP continued VMP at the physician’s discretion. The overall response rates after VMP and after Rd were 66.7% and 86.1%, including CR rates of 5.6% and 36.1%, respectively. In a median follow-up period of 34.3 months, the progression-free survival and overall survival rates at 3 years were 43.2% and 81.3%, respectively. Grade 3–4 hematological AEs included neutropenia (39% with VMP and 24% with Rd) and thrombocytopenia (11% with VMP and 3% with Rd). There was no death due to an AE. In conclusion, sequential therapy with VMP followed by Rd is effective and mostly feasible for transplant-ineligible NDMM. The study is registered as UMIN000034815..

Medienart:

E-Artikel

Erscheinungsjahr:

2019

Erschienen:

2019

Enthalten in:

Zur Gesamtaufnahme - volume:99

Enthalten in:

Annals of hematology - 99(2019), 1 vom: 25. Nov., Seite 137-145

Sprache:

Englisch

Beteiligte Personen:

Isa, Reiko [VerfasserIn]
Uoshima, Nobuhiko [VerfasserIn]
Takahashi, Ryoichi [VerfasserIn]
Nakano-Akamatsu, Sonoko [VerfasserIn]
Kawata, Eri [VerfasserIn]
Kaneko, Hiroto [VerfasserIn]
Shimura, Kazuho [VerfasserIn]
Kamitsuji, Yuri [VerfasserIn]
Takimoto-Shimomura, Tomoko [VerfasserIn]
Mizutani, Shinsuke [VerfasserIn]
Chinen, Yoshiaki [VerfasserIn]
Ohshiro, Muneo [VerfasserIn]
Fujino, Takahiro [VerfasserIn]
Kawaji, Yuka [VerfasserIn]
Uchiyama, Hitoji [VerfasserIn]
Sasaki, Nana [VerfasserIn]
Tsukamoto, Taku [VerfasserIn]
Shimura, Yuji [VerfasserIn]
Kobayashi, Tsutomu [VerfasserIn]
Taniwaki, Masafumi [VerfasserIn]
Kuroda, Junya [VerfasserIn]

Links:

Volltext [lizenzpflichtig]

Themen:

Bortezomib
Lenalidomide
Multiple myeloma
Transplant-ineligible

RVK:

RVK Klassifikation

Anmerkungen:

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

doi:

10.1007/s00277-019-03859-9

funding:

Förderinstitution / Projekttitel:

PPN (Katalog-ID):

OLC2091714364

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