Improved long-term survival rate in the responders to bortezomib, cyclophosphamide, dexamethasone induction therapy in a transplant-eligible cohort of predominantly middle-age multiple myeloma patients
BACKGROUND: Multiple myeloma (MM) represents the second most common hematologic malignancy (15%). Induction with bortezomib, cyclophosphamide, and dexamthasone VCd (d: low dose dexamthasone) regimen is widely used due to its high effectiveness, low toxicity and good tolerability, particularly with r...
| Main Authors: | , , , , , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
King Faisal Specialist Hospital and Research Centre
2024-03-01
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| Series: | Annals of Saudi Medicine |
| Online Access: | http://www.annsaudimed.net/doi/10.5144/0256-4947.2024.93 |
| _version_ | 1797205322122657792 |
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| author | Ahmed Kotb Abdrabou Fahad Al Sharif Riad El Fakih Hazaa Al Zahrani Ruah Al Yamany Mostafa Saleh Saud Alhayli Zakia Al Somali Ahmad Alotaibi AlFadel AlShaibani Farah Deeba Maryam Asif Syed Ahmed Osman Ali Ahmed Feras Al Fraih Marwan Shaheen Ali Alahmari Walid Rasheed Naeem Arshad Chaudhri Fahad Al Mohareb Mahmoud Aljurf Amr Hanbali |
| author_facet | Ahmed Kotb Abdrabou Fahad Al Sharif Riad El Fakih Hazaa Al Zahrani Ruah Al Yamany Mostafa Saleh Saud Alhayli Zakia Al Somali Ahmad Alotaibi AlFadel AlShaibani Farah Deeba Maryam Asif Syed Ahmed Osman Ali Ahmed Feras Al Fraih Marwan Shaheen Ali Alahmari Walid Rasheed Naeem Arshad Chaudhri Fahad Al Mohareb Mahmoud Aljurf Amr Hanbali |
| author_sort | Ahmed Kotb Abdrabou |
| collection | DOAJ |
| description | BACKGROUND: Multiple myeloma (MM) represents the second most common hematologic malignancy (15%). Induction with bortezomib, cyclophosphamide, and dexamthasone VCd (d: low dose dexamthasone) regimen is widely used due to its high effectiveness, low toxicity and good tolerability, particularly with renal impairment. Real-world data on the use of VCD in clinical practice is lacking. OBJECTIVES: Evaluate the real-world experience of the VCD regimen DESIGN: Retrospective SETTING: Tumor registry database of tertiary cancer care center PATIENTS AND METHODS: Newly diagnosed MM patients who received VCD induction and underwent autologous stem cell transplant (ASCT) from July 2007 to July 2020 MAIN OUTCOME MEASURES: Response evaluation, progression-free survival (PFS) and overall survival (OS). SAMPLE SIZE: 87 patients RESULTS: Of 102 patients who started induction with VCd, 87 patients experienced a partial response or more overall response rate of 85%). The median age of these 87 patients at diagnosis was 52 years, of which 29.9% presented with renal impairment and 60.3% of patients had stage 2 by the Revised International Staging System (R-ISS). Patients with a standard cytogenetic risk achieved a better response compared to those with a poor cytogenetic risk (P=.044). The post-induction response rates were 6.9% stringent complete remission (sCR), 35% complete remission (CR); 41.4% very good partial response (VGPR), and 16.1% partial response (PR), respectively; the response rates became greater for sCR and CR post-transplantation at day 100 with 16.1% sCR, 35.6% CR, 32.2% VGPR and 16.1% PR, respectively. The median PFS was 49 months and 5 years OS was 84%. PFS was better in patients who achieved sCR vs PR (83 vs 35 months, P=.037). High LDH, high-risk cytogenetic and stage 3 R-ISS showed a worse median PFS and OS. CONCLUSIONS: VCD induction in newly diagnosed MM is highly effective, convenient, tolerable and affordable regimen, especially in low and middle-income countries with limited resources, also with favorable outcomes and survival. while those who did not respond successfully shifted to VRD or VTD. LIMITATIONS: The usual limitations of a retrospective analysis using registry-level data, no data on quality of life. |
| first_indexed | 2024-04-24T08:49:16Z |
| format | Article |
| id | doaj.art-d66c5872efd243c381a2b8bbe39d109d |
| institution | Directory Open Access Journal |
| issn | 0256-4947 0975-4466 |
| language | English |
| last_indexed | 2024-04-24T08:49:16Z |
| publishDate | 2024-03-01 |
| publisher | King Faisal Specialist Hospital and Research Centre |
| record_format | Article |
| series | Annals of Saudi Medicine |
| spelling | doaj.art-d66c5872efd243c381a2b8bbe39d109d2024-04-16T12:52:39ZengKing Faisal Specialist Hospital and Research CentreAnnals of Saudi Medicine0256-49470975-44662024-03-014429310310.5144/0256-4947.2024.93Improved long-term survival rate in the responders to bortezomib, cyclophosphamide, dexamethasone induction therapy in a transplant-eligible cohort of predominantly middle-age multiple myeloma patientsAhmed Kotb Abdrabou0Fahad Al Sharif1Riad El Fakih2Hazaa Al Zahrani3Ruah Al Yamany4Mostafa Saleh5Saud Alhayli6Zakia Al Somali7Ahmad Alotaibi8AlFadel AlShaibani9Farah Deeba10Maryam Asif11Syed Ahmed Osman Ali Ahmed12Feras Al Fraih13Marwan Shaheen14Ali Alahmari15Walid Rasheed16Naeem Arshad Chaudhri17Fahad Al Mohareb18Mahmoud Aljurf19Amr Hanbali20From the Department of Hematology and Bone Marrow Transplant, Zagazig University, Zagazig, EgyptFrom the Adult Hematology, Stem Cell Transplant and Cellular Therapy, Oncology Center, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi ArabiaFrom the Adult Hematology, Stem Cell Transplant and Cellular Therapy, Oncology Center, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi ArabiaFrom the Adult Hematology, Stem Cell Transplant and Cellular Therapy, Oncology Center, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi ArabiaFrom the Adult Hematology, Stem Cell Transplant and Cellular Therapy, Oncology Center, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi ArabiaFrom the Adult Hematology, Stem Cell Transplant and Cellular Therapy, Oncology Center, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi ArabiaFrom the Adult Hematology, Stem Cell Transplant and Cellular Therapy, Oncology Center, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi ArabiaFrom the Adult Hematology, Stem Cell Transplant and Cellular Therapy, Oncology Center, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi ArabiaFrom the Adult Hematology, Stem Cell Transplant and Cellular Therapy, Oncology Center, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi ArabiaFrom the Adult Hematology, Stem Cell Transplant and Cellular Therapy, Oncology Center, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi ArabiaFrom the Adult Hematology, Stem Cell Transplant and Cellular Therapy, Oncology Center, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi ArabiaFrom the Adult Hematology, Stem Cell Transplant and Cellular Therapy, Oncology Center, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi ArabiaFrom the Adult Hematology, Stem Cell Transplant and Cellular Therapy, Oncology Center, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi ArabiaFrom the Adult Hematology, Stem Cell Transplant and Cellular Therapy, Oncology Center, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi ArabiaFrom the Adult Hematology, Stem Cell Transplant and Cellular Therapy, Oncology Center, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi ArabiaFrom the Adult Hematology, Stem Cell Transplant and Cellular Therapy, Oncology Center, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi ArabiaFrom the Adult Hematology, Stem Cell Transplant and Cellular Therapy, Oncology Center, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi ArabiaFrom the Adult Hematology, Stem Cell Transplant and Cellular Therapy, Oncology Center, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi ArabiaFrom the Adult Hematology, Stem Cell Transplant and Cellular Therapy, Oncology Center, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi ArabiaFrom the Adult Hematology, Stem Cell Transplant and Cellular Therapy, Oncology Center, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi ArabiaFrom the Adult Hematology, Stem Cell Transplant and Cellular Therapy, Oncology Center, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi ArabiaBACKGROUND: Multiple myeloma (MM) represents the second most common hematologic malignancy (15%). Induction with bortezomib, cyclophosphamide, and dexamthasone VCd (d: low dose dexamthasone) regimen is widely used due to its high effectiveness, low toxicity and good tolerability, particularly with renal impairment. Real-world data on the use of VCD in clinical practice is lacking. OBJECTIVES: Evaluate the real-world experience of the VCD regimen DESIGN: Retrospective SETTING: Tumor registry database of tertiary cancer care center PATIENTS AND METHODS: Newly diagnosed MM patients who received VCD induction and underwent autologous stem cell transplant (ASCT) from July 2007 to July 2020 MAIN OUTCOME MEASURES: Response evaluation, progression-free survival (PFS) and overall survival (OS). SAMPLE SIZE: 87 patients RESULTS: Of 102 patients who started induction with VCd, 87 patients experienced a partial response or more overall response rate of 85%). The median age of these 87 patients at diagnosis was 52 years, of which 29.9% presented with renal impairment and 60.3% of patients had stage 2 by the Revised International Staging System (R-ISS). Patients with a standard cytogenetic risk achieved a better response compared to those with a poor cytogenetic risk (P=.044). The post-induction response rates were 6.9% stringent complete remission (sCR), 35% complete remission (CR); 41.4% very good partial response (VGPR), and 16.1% partial response (PR), respectively; the response rates became greater for sCR and CR post-transplantation at day 100 with 16.1% sCR, 35.6% CR, 32.2% VGPR and 16.1% PR, respectively. The median PFS was 49 months and 5 years OS was 84%. PFS was better in patients who achieved sCR vs PR (83 vs 35 months, P=.037). High LDH, high-risk cytogenetic and stage 3 R-ISS showed a worse median PFS and OS. CONCLUSIONS: VCD induction in newly diagnosed MM is highly effective, convenient, tolerable and affordable regimen, especially in low and middle-income countries with limited resources, also with favorable outcomes and survival. while those who did not respond successfully shifted to VRD or VTD. LIMITATIONS: The usual limitations of a retrospective analysis using registry-level data, no data on quality of life.http://www.annsaudimed.net/doi/10.5144/0256-4947.2024.93 |
| spellingShingle | Ahmed Kotb Abdrabou Fahad Al Sharif Riad El Fakih Hazaa Al Zahrani Ruah Al Yamany Mostafa Saleh Saud Alhayli Zakia Al Somali Ahmad Alotaibi AlFadel AlShaibani Farah Deeba Maryam Asif Syed Ahmed Osman Ali Ahmed Feras Al Fraih Marwan Shaheen Ali Alahmari Walid Rasheed Naeem Arshad Chaudhri Fahad Al Mohareb Mahmoud Aljurf Amr Hanbali Improved long-term survival rate in the responders to bortezomib, cyclophosphamide, dexamethasone induction therapy in a transplant-eligible cohort of predominantly middle-age multiple myeloma patients Annals of Saudi Medicine |
| title | Improved long-term survival rate in the responders to bortezomib, cyclophosphamide, dexamethasone induction therapy in a transplant-eligible cohort of predominantly middle-age multiple myeloma patients |
| title_full | Improved long-term survival rate in the responders to bortezomib, cyclophosphamide, dexamethasone induction therapy in a transplant-eligible cohort of predominantly middle-age multiple myeloma patients |
| title_fullStr | Improved long-term survival rate in the responders to bortezomib, cyclophosphamide, dexamethasone induction therapy in a transplant-eligible cohort of predominantly middle-age multiple myeloma patients |
| title_full_unstemmed | Improved long-term survival rate in the responders to bortezomib, cyclophosphamide, dexamethasone induction therapy in a transplant-eligible cohort of predominantly middle-age multiple myeloma patients |
| title_short | Improved long-term survival rate in the responders to bortezomib, cyclophosphamide, dexamethasone induction therapy in a transplant-eligible cohort of predominantly middle-age multiple myeloma patients |
| title_sort | improved long term survival rate in the responders to bortezomib cyclophosphamide dexamethasone induction therapy in a transplant eligible cohort of predominantly middle age multiple myeloma patients |
| url | http://www.annsaudimed.net/doi/10.5144/0256-4947.2024.93 |
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