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Induction Therapy with Bortezomib, Thalidomide and Dexamethasone (VTD) in Caucasian Patients with Multiple Myeloma: A Single Center Experience

Normann Steiner, Stephanie Riehl, David Nachbaur, Wolfgang Willenbacher, Gunther Gastl and Eberhard Gunsilius

Objective: In clinical trials, the combination of bortezomib, thalidomide, and dexamethasone (VTD) has shown excellent results as induction treatment in patients with multiple myeloma. However, “real-life” data in unselected Caucasian patients are lacking.

Methods: We retrospectively analyzed 41 patients treated with VTD between 2005 and 2014. 

Results: Post induction, the overall response rate was 78%, with ≥very good partial response (≥VGPR) in 54% and near complete/complete responses (nCR/CR) in 17% of the patients  respectively. For patients proceeding to autologous stem cell transplantation (ASCT), post-transplant rates were 96% ≥VGPR and 48% nCR/CR. Median progression free survival (PFS) was 24 months and the estimated 1-year and 2-year overall survival (OS) rates were 95% and 76%, respectively. Subgroup analyses revealed significantly longer OS and PFS in patients with a ≥VGPR as first response status compared to those with a <VGPR [OS 44 vs. 25 months (p=0.036); PFS 29.5 vs. 16 months (p=0.011)], as well as in patients who underwent ASCT compared to not transplanted patients [OS 41 vs. 23.5 months (p=0.002); PFS 28 vs. 23 months (p=0.003)]. In 6 patients (15%) therapy was switched to another regimen due to lack of response (<PR, n=4), cardiac decompensation (n=1) or prolonged neutropenia (n=1). Non-hematological grade III/IV toxicities were peripheral neuropathy (2%), infections (7%), herpes zoster (5%), and thromboembolic events (2%). Dose reductions of thalidomide and/or bortezomib were necessary in 24% of the patients because of peripheral neuropathy.

Conclusion: The VTD regimen was found to be a highly effective and well tolerated induction regimen for multiple myeloma patients outside clinical trials.