Disease biology alters the response to frontline bortezomib, lenalidomide and dexamethasone in Multiple Myeloma

Amany R Keruakous*, Silas Day and Carrie Yuen

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.

The purpose of this study is to identify biological markers that could potentially affect the response rate to upfront VRd.

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.

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).

Conclusion: We conclude that IgG subtype multiple myeloma is associated with a suboptimal response to frontline VRd.

Keywords:

Published on: Feb 13, 2021 Pages: 10-15

Full Text PDF Full Text HTML DOI: 10.17352/2581-5407.000037
CrossMark Publons Harvard Library HOLLIS Search IT Semantic Scholar Get Citation Base Search Scilit OAI-PMH ResearchGate Academic Microsoft GrowKudos Universite de Paris UW Libraries SJSU King Library SJSU King Library NUS Library McGill DET KGL BIBLiOTEK JCU Discovery Universidad De Lima WorldCat VU on WorldCat