Bortezomib-thalidomide-dexamethasone-cisplatin-doxorubicin-cyclophosphamide-etoposide as a Salvage and Bridging Regimen before Hematopoietic Stem Cell Transplantation for Relapsed or Refractory Multiple Myeloma

抄録

Objective Currently, treatment of relapsed or refractory multiple myeloma is challenging. Although bortezomib-thalidomide-dexamethasone-cisplatin-doxorubicin-cyclophosphamide-etoposide (VTD-PACE), a potent combination of a proteasome inhibitor, immunomodulatory drug, and conventional chemotherapeutics, is a widely used regimen, its efficacy and safety are unclear.

Methods and Patients We retrospectively analyzed the clinical data of 35 patients treated with VTD-PACE.

Results The overall response rate was 65.7% (complete response, 5.7%). The median progression-free survival (PFS) and overall survival (OS) were 8.0 (95% confidence interval [CI], 0.9-15.0) and 20.0 (95% CI, 17.5-22.5) months, respectively. Twenty-two (57.1%) patients developed grade 3-4 infections, and no therapy-related deaths occurred. Sixteen of 25 patients (64%) underwent stem cell harvest successfully with more than 2.0×10⁶/kg of CD34 cells after VTD-PACE. Twenty-two patients underwent autologous or allogeneic stem cell transplantation (SCT). The response and survival durations were short in patients without SCT after VTD-PACE (median PFS: 4.0 [95% CI, 2.7-5.3] months; OS: 14.0 [6.9-21.0] months); however, these responses significantly improved with SCT following VTD-PACE. The PFS was 8.0 (NA) months (p = 0.024), and the OS was 21.0 (19.1-22.8) months (p = 0.019).

Conclusion VTD-PACE is an effective and tolerable salvage regimen and feasible bridging therapy for SCT.