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Bortezomib plus dexamethasone versus reduced-dose bortezomib, thalidomide plus dexamethasone as induction treatment before autologous stem cell transplantation in newly diagnosed multiple myeloma. 2011
Philippe Moreau, and
Herve Avet-Loiseau, and
Thierry Facon, and
Michel Attal, and
Mourad Tiab, and
Cyrille Hulin, and
Chantal Doyen, and
Laurent Garderet, and
Edouard Randriamalala, and
Carla Araujo, and
Gérard Lepeu, and
Gerald Marit, and
Denis Caillot, and
Martine Escoffre, and
Bruno Lioure, and
Lotfi Benboubker, and
Brigitte Pégourié, and
Brigitte Kolb, and
Anne Marie Stoppa, and
Jean-Gabriel Fuzibet, and
Olivier Decaux, and
Mamoun Dib, and
Christian Berthou, and
Carine Chaleteix, and
Catherine Sebban, and
Catherine Traullé, and
Jean Fontan, and
Marc Wetterwald, and
Pascal Lenain, and
Claire Mathiot, and
Jean-Luc Harousseau
University Hospital, Nantes, France.
The Intergroupe Francophone du Myelome conducted a randomized trial to compare bortezomib-dexamethasone (VD) as induction before high-dose therapy (HDT) and autologous stem cell transplantation (ASCT) to a combination consisting of reduced doses of bortezomib and thalidomide plus dexamethasone (vtD) in patients with multiple myeloma. Overall, a total of 199 patients were centrally randomly assigned to receive VD or vtD. After 4 cycles, the complete response (CR) rate was the same in both groups (13% in the vtD arm, 12% in the VD arm, P = .74). However, the CR plus very good partial response (VGPR) rate was significantly higher in the vtD arm (49% vs 36%, P = .05). After ASCT, the CR plus VGPR rate was significantly higher in the vtD arm (74% vs 58%, P = .02). The reduced doses of bortezomib and thalidomide translated into a reduced incidence of peripheral neuropathy (PN): grade ≥ 2 PN were reported in 34% in the VD arm versus 14% in the vtD arm (P = .001). vtD, including reduced doses of bortezomib and thalidomide, yields higher VGPR rates compared with VD and can be considered a new effective triplet combination before HDT/ASCT.
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