Japanese Journal of Clinical Oncology Advance Access originally published online on June 1, 2009
Japanese Journal of Clinical Oncology 2009 39(7):449-455; doi:10.1093/jjco/hyp046
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© The Author (2009). Published by Oxford University Press. All rights reserved
Retrospective Comparison of Bortezomib-containing Regimens with Vincristine–Doxorubicin–Dexamethasone (VAD) as Induction Treatment Prior to Autologous Stem Cell Transplantation for Multiple Myeloma
1 Hematology–Oncology Clinic, National Cancer Center, Goyang
2 Department of Hematology, The Catholic University of Korea
3 Department of Laboratory Medicine, The Catholic University of Medicine, Seoul, Korea
For reprints and all correspondence: Chang-Ki Min, Department of Internal Medicine, St Mary's Hospital, The Catholic University of Korea, #62 Yeouido-Dong, Youngdungpo-Gu, Seoul 150-713, Korea. E-mail: ckmin{at}catholic.ac.kr
Received January 6, 2009; accepted April 19, 2009
Objective: Patients with multiple myeloma (MM) achieving high-quality responses, defined as a complete response (CR) and a very good partial response (VGPR) after transplant, benefit from high-dose therapy followed by autologous stem cell transplantation (ASCT). Induction pre-transplantation treatment with vincristine, doxorubicin and dexamethasone (VAD) is currently being replaced by new targeted agents with high anti-myeloma activity. The use of these novel agents may increase the CR + VGPR rate before ASCT, which may improve post-transplantation responses and survival.
Methods: We performed a retrospective analysis of 69 patients with MM who received bortezomib-containing regimens (n = 30) or VAD (n = 39) before collection of peripheral blood stem cells and ASCT.
Results: Objective response rate (at least a partial response) prior to ASCT was documented in 27 (90%) of 30 and 31 (81.6%) of evaluable 38 patients with bortezomib-containing regimens and VAD, respectively. The difference between the two groups was not significant (P = 0.494). However, the high-quality response rate with VGPR or more in the bortezomib group was significantly higher compared with the VAD group (66.7% vs. 34.2%, respectively, P = 0.006). The superiority of bortezomib-containing regimens in the high-quality response rate remained significant for only the newly diagnosed patients (n = 16, P = 0.008). The engraftment data as well as stem cell harvesting were comparable between the two groups. The major bortezomib-related toxicities were thrombocytopenias and peripheral neuropathies; toxicities of VAD were hematologic and infectious. After ASCT, the difference between the two groups did not reach the level of statistical significance with respect to progression-free survival and overall survival (P = 0.498 and 0.835, respectively).
Conclusions: The results of this retrospective comparison of bortezomib-containing regimens with the VAD as induction treatment prior to ASCT for MM provided a demonstration of the superiority of bortezomib therapy in terms of achieving a high-quality response. However, survivals following ASCT did not differ according to the induction regimens.
Key Words: multiple myeloma • bortezomib • VAD • autologous stem cell transplantation • response • survival