VRD versus VCD induction chemotherapy followed by autologous stem cell transplantation in newly diagnosed multiple myeloma

doi:10.3969/j.issn.1006-7795.2021.04.017

Abstract

Abstract: Objective To evaluate the effects of bortezomib-lenalidomide-dexamethasone (VRD) and bortezomib-cyclophosphamide- dexamethasone (VCD) induction chemotherapy on the response, stem cell collection and prognosis in multiple myeloma(MM) patients undergoing autologous stem cell transplantation(ASCT). Methods We retrospective analyzed clinical data from 110 newly diagnosed multiple myeloma(NDMM) patients who received autologous stem cell transplantation after VRD or VCD induction chemotherapy with available complete follow-up data between October 2010 and October 2019 in Beijing Chaoyang Hospital. Results The depth of response and minimal residual disease(MRD)-negative rate were improved in both groups after ASCT. At the 3rd month after ASCT, the complete response(CR)/stringent complete response(sCR) rate in VCD group improved from 39.4% to 59.1% (P=0.001), and the MRD-negative rate improved from 16.7% to 41.7% (P=0.003). While the CR/sCR rate in VRD group improved from 51.2% to 67.6% (P=0.008), and the MRD-negative rate detected by next generation flow cytometry improved from 26.1% to 47.8% (P=0.059). Those who carried high-risk cytogenetics (t(4;14), t(14;16) and del(17p)) had similar response rates. As to survival analysis, the median progression-free survival(PFS) and overall survival(OS) in VCD group were 72.0 and 98.0 months, respectively, while neither had been reached in the VRD group (PFS: P=0.856; OS: P=0.382). The median number of CD34-positive cells was lower in VRD group than that in VCD group (3.52×10⁶/kg vs 4.65×10⁶/kg, P=0.046), while collection failure rates in the two groups did not show statistically significant difference. The number of CD34-positive cells tended to decrease after more than 4 courses of VRD induction therapies, while it remained stable between 3 to 6 courses of VCD induction therapies. Conclusion VRD induction chemotherapy could achieve deeper response than VCD, without significant effect on survival prognosis. VRD induction regimen could result in less stem cells harvested, thus the courses before stem cell collection should be no more than four.

Key words: multiple myeloma, autologous stem cell transplantation, induction therapy, minimal residual disease, stem cell collection

CLC Number:

R733.3

Wang Huijuan, Yang Guangzhong, Jian Yuan, Geng Chuanying, Zhou Huixing, Chen Wenming. VRD versus VCD induction chemotherapy followed by autologous stem cell transplantation in newly diagnosed multiple myeloma[J]. Journal of Capital Medical University, 2021, 42(4): 615-622.

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URL: https://journal03.magtech.org.cn/Jweb_sdykdxxb/EN/10.3969/j.issn.1006-7795.2021.04.017

https://journal03.magtech.org.cn/Jweb_sdykdxxb/EN/Y2021/V42/I4/615

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