Combination Therapy Based On Bortezomib Atients With Newly Diagnosed Multiple Myeloma

Objective:. Novel drugs, such as bortezomib, have significantly improved the response rates in multiple myeloma (MM), but little has been reported on bortezomib-based therapies in Chinese patients.Methods:We report our results of patients received combination therapy including bortezomib plus dexamethasone (BD) and the triplet combinations of BD with adriamycin (BAD), cyclophosphamide (BCD), thalidomide (BDT) included patients with newly diagnosed symptomatic MM between February1,2006and December31,2010in our center. Among the102eligible patients in the study population, the patients received BDT (n=35), BD (n=19), BCD (n=32) or BAD (n=16).Results:(1) The overall response rate (≥partial response, PR) of all the patients was85.3%(including27.5%very good partial response (VGPR) and23.5%complete response/near complete response (CR/nCR). There were85.7%of patients who achieved partial response (≥PR) in BDT group,90.6%in BCD group, and93.7%in BAD group which were higher than in BD group (68.4%). The overall response rates of BCD group was significant higher than BD group, P=0.044. After one cycle of treatment, every group can reach high response rate, both overall response rate and PR after one cycle for BCD group was superior to BD (P=0.019,0.046).(2) The median PFS was15.0months (95%CI:9.8-20.2months) in the patients who received BDT,12.0months (95%CI:8.1-15.8months) in the patients who received BD,13.0months (95%CI:5.9-20.1months) in the patients who received BCD and12.0 months (95%CI:7.8-16.2months) in the patients who received BAD. No significant differences in PFS were observed between the groups. The median OS for BDT arm was35.0months, the median OS for other arms were not reached, OS of BDT arm was significant longer than BCD (P=0.035). No matter how treatment patients received, neither younger patients (<65years) nor older patients (≥65years), the PFS and OS had no significant difference.(3) Compared to the older patients (≥65years), younger patients (<65years) had significant longer PFS and OS (P=0.009,0.004). The level of serum albumin, β2microglobulin, Durie-Salmon staging can affect patients’ PFS while patients with better Durie-Salmon staging, lower hemoglobin levels had longer OS, which were with significant difference.(4) The frequently observed toxicities were neutropenia, thrombocytopenia, fatigue, infection, herpes zoster, and peripheral neuropathy. A significant trend towards grade2or3peripheral neuropathy during BDT therapy was observed compared to the other groups (P=0.028).Conclusions:Our experience indicated that combination chemotherapy of triplet combinations were superior to BD. Age, level of serum albumin, β2microglobulin, Durie-Salmon staging, proportion of bone marrow plasma cells, hemoglobin levels and early effect after treatment can affect patients’ OS and PFS. The frequently observed toxicities were neutropenia, thrombocytopenia, fatigue, infection, herpes zoster, and peripheral neuropathy but serious adverse events were rare in the Chinese patients with MM who received bortezomib-based chemotherapy.