Disease biology alters the response to frontline bortezomib, lenalidomide and dexamethasone in Multiple Myeloma
<p>Background: Achievement of the best initial response to induction regimen in multiple myeloma is a prognostic factor for disease outcome. The triplet regimen-bortezomib, lenalidomide, and dexamethasone, VRd, is the preferred induction regimen in newly diagnosed Multiple Myeloma (MM) due to...
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| Main Authors: | , , |
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| Format: | Book |
| Published: |
Global Journal of Cancer Therapy - Peertechz Publications,
2021-02-13.
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| Summary: | <p>Background: Achievement of the best initial response to induction regimen in multiple myeloma is a prognostic factor for disease outcome. The triplet regimen-bortezomib, lenalidomide, and dexamethasone, VRd, is the preferred induction regimen in newly diagnosed Multiple Myeloma (MM) due to its favorable impact on overall survival. However, recent studies showed a deeper response and superior progression-free survival with quadruplet regimen, daratumumab-VRd, when compared to VRd. Yet, the quadruplet regimen also comes with additional toxicities. Balancing efficacy and toxicity in selecting an induction regimen is a challenge due to advanced age and comorbidities in the multiple myeloma population.</p><p>The purpose of this study is to identify biological markers that could potentially affect the response rate to upfront VRd.</p><p>Patients and methods: For this cross-sectional study, we included patients with MM treated with frontline VRd starting April 2011 through May 2018. We analyzed the correlation between patient demographics, disease biology, disease burden and stage at diagnosis, and response to therapy.</p><p>Results: After four cycles of VRd, we analyzed the response rate on 120 subjects. The overall response rates to VRd were 50% of patients achieved Very Good Partial Response (VGPR) or better, 43% achieved Partial Response (PR), 5% did not respond to treatment. We showed a statistically significant difference in treatment outcomes between myeloma subtypes particularly involved immunoglobulin, IgA, and IgG myeloma. We report an increased incidence of VGPR or better in IgA myeloma (79%) as compared to IgG myeloma (37%) (P-Value < 0.0006).</p><p>Conclusion: We conclude that IgG subtype multiple myeloma is associated with a suboptimal response to frontline VRd.</p> |
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| DOI: | 10.17352/2581-5407.000037 |