Article Abstract

Treatment outcome and prognostic factor in fit elderly patients with multiple myeloma received frontline induction of bortezomib based regimen (PAD or VCD)

Authors: Yan Wang, Wenbin Xu, Yang Shen, Pengpeng Xu, Jianqing Mi, Hua Yan, Junmin Li


Background: Few clinical trials have head to head compared bortezomib, doxorubicin and dexamethasone (PAD) and bortezomib, cyclophosphamide and dexamethasone (VCD) regimen in multiple myeloma (MM), especially for the elderly patients.
Methods: In this study, we included 64 fit patients who were treated with frontline induction of PAD or PCD. The effect of the bortezomib triple regimens and prognostic factors were evaluated.
Results: Among the 64 patients, 20 (31.25%) were with international stage III disease. The median age was 67 years [65–75]. After completion of induction therapy, the overall response rate (ORR) 93.7%, complete remission (CR) rate was 32.8%. With a median follow up time of 28 [8–79] months, the median progressive free survival (PFS) and overall survival (OS) were 21.6 and 56.8 months respectively. There was no difference in term of CR rate, PFS, OS and adverse effects between two groups of patients induced by PAD or VCD regimens. Multivariable Cox analysis showed that low albumin (ALB) (<35 g/L) and elevate lactate dehydrogenase (LDH) (> normal) were independent prognostic factor of OS (OR=2.980, 95% CI, 1.021–8.699, P=0.025 and OR=2.715, 95% CI, 1.184–6.223, P=0.018).
Conclusions: PAD and VCD regimens showed equivalent efficacy and tolerability for fit elderly MM patients. Low ALB and high LDH were adverse prognostic factors associated with inferior OS, even in the era of novel agents.