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Título
Sequential vs alternating administration of VMP and Rd in elderly patients with newly diagnosed MM
Autor(es)
Palabras clave
VMP
Mieloma múltiple
Fecha de publicación
2016-01-28
Editor
American Society of Hematology
Citación
Mateos MV, Martínez-López J, Hernández MT, Ocio EM, Rosiñol L, Martínez R, Teruel AI, Gutiérrez NC, Martín Ramos ML, Oriol A, Bargay J, Bengoechea E, González Y, Pérez de Oteyza J, Gironella M, Encinas C, Martín J, Cabrera C, Paiva B, Cedena MT, Puig N, Bladé J, Lahuerta JJ, San-Miguel J. Sequential vs alternating administration of VMP and Rd in elderly patients with newly diagnosed MM. Blood. 2016 Jan 28;127(4):420-5. doi: 10.1182/blood-2015-08-666537. Epub 2015 Oct 23. PMID: 26500339.
Resumen
[EN]Bortezomib plus melphalan and prednisone (VMP) and lenalidomide plus low-dose
dexamethasone (Rd) are 2 standards of care for elderly untreated multiple myeloma (MM)
patients. We planned to use VMP and Rd for 18 cycles in a sequential or alternating
scheme. Patients (233) with untreated MM, >65 years, were randomized to receive 9 cycles
of VMP followed by 9 cycles of Rd (sequential scheme; n 5 118) vs 1 cycle of VMP followed
by 1 cycle of Rd, and so on, up to 18 cycles (alternating scheme; n 5 115). VMP consisted
of one 6-week cycle of bortezomib using a biweekly schedule, followed by eight 5-week
cycles of once-weekly VMP. Rd included nine 4-week cycles of Rd. The primary end points
were 18-month progression free survival (PFS) and safety profile of both schemes. The
18-month PFS was 74% and 80% in the sequential and alternating arms, respectively
(P 5 .21). The sequential and alternating groups exhibited similar hematologic and nonhematologic toxicity. Both arms yielded similar complete response rate (42% and 40%),
median PFS (32 months vs 34 months, P 5 .65), and 3-year overall survival (72% vs 74%, P 5 .63). The benefit of both schemes was
remarkable in patients aged 65 to 75 years. In addition, achieving complete and immunophenotypic response was associated with
better outcome. The present approach, based on VMP and Rd, is associated with high efficacy and acceptable toxicity profile with no
differences between the sequential and alternating regimens
URI
ISSN
0006-4971
DOI
10.1182/blood-2015-08-666537
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