Modified dose of melphalan-prednisone in multiple myeloma patients receiving bortezomib plus melphalan-prednisone treatment
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Background/Aims: Bortezomib plus melphalan-prednisone (VMP) is a standard treatment for multiple myeloma, particularly for patients who are ineligible for high-dose therapy. However, early discontinuation or treatment modification is often needed owing to adverse events. The aim of this study was to investigate the clinical outcomes of modifying the dose of melphalan-prednisone (MP) in patients receiving VMP. Methods: We examined 67 patients who received a modified dose of MP, and 38 patients who received the regularly planned dose of MP. We then analyzed clinical differences between the groups. Results: Although there was no difference in the proportion of discontinuation due to adverse events between dose groups, more patients in the planned-dose group experienced earlier discontinuation in general. The overall response rate (ORR) was 81.0% and complete response (CR) rate was 30.5%. After a median 15.7 months of follow-up, the median progression-free survival (PFS) and overall survival (OS) were 25.0 and 47.8 months, respectively. There was no significant difference in the ORR, CR, PFS, and OS of the two dose groups. A median of four cycles were delivered, and the median cumulative bortezomib dose was 41.6 mg/m2. The median PFS in patients with doses ≥ 41.6 mg/m2 was longer than that in patients with doses < 41.6 mg/m2 (35.1 months vs. 9.6 months). However, when MP was < 50% of the planned dose, PFS and OS were poor. Conclusions: Modifying the dose of MP might be a feasible and effective therapeutic approach for multiple myeloma patients receiving VMP treatment.
Abstract
Background/Aims: Bortezomib plus melphalan-prednisone (VMP) is a standard treatment for multiple myeloma, particularly for patients who are ineligible for high-dose therapy. However, early discontinuation or treatment modification is often needed owing to adverse events. The aim of this study was to investigate the clinical outcomes of modifying the dose of melphalan-prednisone (MP) in patients receiving VMP. Methods: We examined 67 patients who received a modified dose of MP, and 38 patients who received the regularly planned dose of MP. We then analyzed clinical differences between the groups. Results: Although there was no difference in the proportion of discontinuation due to adverse events between dose groups, more patients in the planned-dose group experienced earlier discontinuation in general. The overall response rate (ORR) was 81.0% and complete response (CR) rate was 30.5%. After a median 15.7 months of follow-up, the median progression-free survival (PFS) and overall survival (OS) were 25.0 and 47.8 months, respectively. There was no significant difference in the ORR, CR, PFS, and OS of the two dose groups. A median of four cycles were delivered, and the median cumulative bortezomib dose was 41.6 mg/m2. The median PFS in patients with doses ≥ 41.6 mg/m2 was longer than that in patients with doses < 41.6 mg/m2 (35.1 months vs. 9.6 months). However, when MP was < 50% of the planned dose, PFS and OS were poor. Conclusions: Modifying the dose of MP might be a feasible and effective therapeutic approach for multiple myeloma patients receiving VMP treatment.
참고문헌 (16)
- Kyle RA, "Multiple myeloma", Blood, 111, pp.2962~2972 (2008)
- Richardson PG, "A phase 2study of bortezomib in relapsed, refractory myeloma", N Engl J Med, 348, pp.2609~2617 (2003)
- Chen D, "Bortezomib as the first proteasome inhibitor anticancer drug : current status and future perspectives", Curr Cancer Drug Targets, 11, pp.239~253 (2011)
- San Miguel JF, "Bortezomib plus melphalan and prednisone for initial treatment of multiple myeloma", N Engl J Med, 359, pp.906~917 (2008)
- Mateos MV, "Bortezomib plus melphalan and prednisone compared with melphalan and prednisone in previously untreated multiple myeloma : updated follow-up and impact of subsequent therapy in the phase III VISTA trial", J Clin Oncol, 28, pp.2259~2266 (2010)
- Mateos MV, "Effect of cumulative bortezomib dose on survival in multiple myeloma patients receiving bortezomib-melphalan-prednisone in the phase III VISTA study", Am J Hematol, 90, pp.314~319 (2015)
- Kim MK, "A prospective, open-label, multicenter, observational study to evaluate the efficacy and safety of bortezomib-melphalan-prednisone as initial treatment for autologous stem cell transplantation-ineligible patients with multiple myeloma", Oncotarget, 8, pp.37605~37618 (2017)
- Richardson PG, "Frequency, characteristics, and reversibility of peripheral neuropathy during treatment of advanced multiple myeloma with bortezomib", J Clin Oncol, 24, pp.3113~3120 (2006)
- Palumbo A, "Revised International Staging System for multiple myeloma : a report from International Myeloma Working Group", J Clin Oncol, 33, pp.2863~2869 (2015)
- Chng WJ, "IMWG consensus on risk stratification in multiple myeloma", Leukemia, 28, pp.269~277 (2014)
- Durie BG, "International uniform response criteria for multiple myeloma", Leukemia, 20, pp.1467~1473 (2006)
- Richardson PG, "Bortezomib or high-dose dexamethasone for relapsed multiple myeloma", N Engl J Med, 352, pp.2487~2498 (2005)
- Ogawa Y, "Phase I", II study of bortezomib-melphalan-prednisolone for previously untreated Japanese patients with multiple myeloma, 2013, pp.104, 912~919
- Niesvizky R, "Community-based phase IIIB trial of three UPFRONT bortezomib-based myeloma regimens", J Clin Oncol, 33, pp.3921~3929 (2015)
- Blimark C, "Multiple myeloma and infections : a population-based study on 9253multiple myeloma patients", Haematologica, 100, pp.107~113 (2015)
- Augustson BM, "Early mortality after diagnosis of multiple myeloma : analysis of patients entered onto the United Kingdom Medical Research Council trials between 1980 and 2002 : Medical Research Council Adult Leukaemia Working Party", J Clin Oncol, 23, pp.9219~9226 (2005)