Combination Regimens for Transplant-Ineligible Myeloma: From the Canadian Myeloma Research Group
Posted: Wednesday, March 24, 2021
Real-world outcomes of triplet bortezomib-containing regimens appear to be similar to each other, as well as similar to lenalidomide/dexamethasone, in terms of overall survival but worse in terms of progression-free survival. These are the findings from a multi-institutional report from the Canadian Myeloma Research Group in patients with multiple myeloma who are not eligible for transplantation. Also, outcomes with the bortezomib/steroid doublet were found to be inferior. Donna Reece, MD, of Princess Margaret Cancer Centre in Toronto, Canada, and colleagues published their results in the British Journal of Haematology.
“This study demonstrated real‐world outcomes in transplant-ineligible multiple myeloma similar to those reported in clinical trials,” the authors wrote.
The study included 1,156 patients in the Canadian Myeloma Research Group database with transplant-ineligible multiple myeloma. Most patients (82%) received one of three treatments containing bortezomib: (1) cyclophosphamide, bortezomib plus dexamethasone or prednisone; (2) bortezomib, melphalan, and prednisone; or (3) a bortezomib-steroid doublet, consisting of bortezomib plus dexamethasone or prednisone. The remaining 18% of patients were treated with lenalidomide and low‐dose dexamethasone.
The bortezomib/steroid doublet yielded the poorest outcomes of both progression-free survival (13 months) and overall survival (31 months). The lenalidomide/dexamethasone treatment was associated with improved progression-free survival (29 months) but no significant differences in overall survival (66 months). Furthermore, there was no significant difference between the two triplet bortezomib treatments. The median progression-free survival was 21 months for both treatments 1 and 2, and the median overall survival was 52 months for treatment 1 and 64 months for treatment 2. A multivariable analysis indicated that disease biology features seemed to be the most important prognostic factors for survival.
The study’s limitations include its retrospective nature, limiting the accuracy of progression-free survival, and the time of response achievement. The authors also noted that comorbidities might have influenced the results.
Disclosure: The study authors’ disclosures may be found at onlinelibrary.wiley.com.