One Multiple Myeloma Induction Therapy Stands Out in Test for Transplant-eligible Patients

Results from a clinical trial support the use of a specific combination drug induction therapy over another three-drug treatment in multiple myeloma patients who are eligible for transplants.

The study indicates the combination of bortezomib-thalidomide-dexamethasone (VTD) is a better induction therapy than bortezomib-cyclophosphamide-dexamethasone (VCD).

VCD was less efficient and was associated with fewer adverse effects. The study “VTD is superior to VCD prior to intensive therapy in multiple myeloma: results of the prospective IFM2013-04 trial,” was published in the journal Blood.

In a randomized clinical trial, researchers compared the effect of VTD and VCD as induction therapy in newly diagnosed multiple myeloma patients. The induction therapy is applied to transplant-eligible multiple myeloma patients before high-dose therapy and autologous stem cell transplant (ASCT).

The goal of induction therapy — a treatment administered to patients who will undergo a transplant procedure — is to prevent the rejection of the new transplant during the early post-transplant period. This is achieved via a combination of drugs that induce an intense early postoperative immune suppression state.

In the new study, 340 patients with newly diagnosed multiple myeloma were randomly assigned to receive VTD or VCD. Patients underwent four cycles of induction therapy. Once the therapy period was finished, researchers evaluated patients’ response in both treatment groups.

They found that while 66.3 percent of the patients in the VTD arm achieved at least a very good partial response (primary endpoint), the VCD arm group registered 56.2 percent, a significantly lower outcome.

Additionally, patients in the VTD group showed a significantly higher overall response rate — 92.3 percent compared to 83.4 percent in the VCD arm.

Adverse effects showed a higher prevalence in the VCD patients when compared to the VTD. Specifically, researchers observed higher levels of hematologic toxicity, including significantly increased rates of grade 3 and 4 anemia, thrombocytopenia (deficiency of platelets in the blood, crucial to stop bleeding) and neutropenia, which is an abnormally low concentration of neutrophils in the blood. Neutrophils make up the majority of circulating white blood cells and are the primary defense against infections.

However, patients in the VTD arm showed a significantly higher rate of peripheral neuropathy, a condition that arises when nerves that carry messages to and from the brain and spinal cord to the rest of the body are damaged. Other toxicities of grade 3 or 4 were rare.

These results indicate patients undergoing ASCT should receive VTD as induction therapy rather than VCD, the study concluded.