Multiple myeloma: VRD effective as induction therapy before autologous transplant

  • Rosiñol L & al.
  • Blood
  • 12 Sep 2019

  • curated by Emily Willingham, PhD
  • Univadis Clinical Summaries
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Takeaway

  • Bortezomib+lenalidomide+dexamethasone (VRD) proved effective for pre-autologous stem cell transplant (ASCT) induction in patients newly diagnosed with multiple myeloma.

Why this matters

  • Authors say VRD induction can be considered “a new standard of care” based on these phase 3 trial results. 

Key results

  • 81.0% completed all phases of treatment. 
  • Among 426 patients who initiated cycle 6, ≥very good partial response rates increased over time:
    • 55.6% by cycle 3;
    • 63.8% by cycle 4;
    • 68.3% by cycle 5; and 
    • 70.4% after induction.
  • After induction, the intent-to-treat complete response (CR) rate was 33.4%, and was similar (34.8%) among patients with high-risk cytogenetics; 6.8% had progression.
  • The intent-to-treat CR rate increased to 44.1% after ASCT and 50.2% after VRD consolidation therapy.
  • Rates of undetectable minimal residual disease (MRD): 
    • 28.8% at induction; 
    • 42.1% at transplant; and
    • 45.2% at consolidation.
  • Most common treatment-emergent adverse events: neutropenia (12.9%) and infection (9.2%).
  • Grade 2+ peripheral neuropathy rate was 17.0%.
  • 13.3% discontinued (34/61 progressive disease; 10/61 toxicity; 5/61 died).

Study design

  • Multicenter PETHEMA/GEM2012 Spanish study of 458 patients aged ≤65 (median, 58) years with newly diagnosed multiple myeloma.
  • Funding: Celgene; Janssen; Pierre Fabré; Spanish government.

Limitations

  • Optimal number of induction cycles and their length remain to be established.
  • No comparator.