title: Bortezomib, liposomal doxorubicin and dexamethasone followed by thalidomide and dexamethasone is an effective treatment for patients with newly diagnosed multiple myeloma with Internatinal Staging System stage II or III, or extramedullary disease.
abstract: We evaluated sequential bortezomib, liposomal doxorubicin and dexamethasone (BDD) followed by thalidomide and dexamethasone (TD) if ≥ partial response (PR) or bortezomib and TD (BTD) if < PR in untreated patients with multiple myeloma with International Staging System stage II/III or extramedullary disease. Of the 42 patients enrolled, two-thirds had cytogenetic abnormalities including high-risk findings [del(13q) by karyotype, t(4;14), loss of p53 or gain 1q] in one-third. After the planned three cycles of BDD, the overall response rate (ORR) was 81% with 40% ≥ very good partial response (VGPR), including 26% near complete and complete responses (nCR/CR). After the additional two cycles of TD or BTD, ORR was 83% with 60% ≥ VGPR including 43% nCR/CR, indicating deeper responses following sequential therapy (p = 0.008). Two-thirds of patients who presented with significant renal impairment had improved renal function. All patients undergoing stem cell harvest had a successful collection. BDD followed by TD or BTD is effective initial therapy for this population with higher-risk myeloma and results in rapid disease control and a high response rate.
authors.affiliation: Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA. Landauh@mskcc.org
authors.forename: Heather
authors.initials: H
authors.lastname: Landau
authors.forename: Neeta
authors.initials: N
authors.lastname: Pandit-Taskar
authors.forename: Hani
authors.initials: H
authors.lastname: Hassoun
authors.forename: Adam
authors.initials: A
authors.lastname: Cohen
authors.forename: Alex
authors.initials: A
authors.lastname: Lesokhin
authors.forename: Nikoletta
authors.initials: N
authors.lastname: Lendvai
authors.forename: Pamela
authors.initials: P
authors.lastname: Drullinsky
authors.forename: Philip
authors.initials: P
authors.lastname: Schulman
authors.forename: Suresh
authors.initials: S
authors.lastname: Jhanwar
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Hoover
authors.forename: Christina
authors.initials: C
authors.lastname: Bello
authors.forename: Elyn
authors.initials: E
authors.lastname: Riedel
authors.forename: Stephen D
authors.initials: SD
authors.lastname: Nimer
authors.forename: Raymond L
authors.initials: RL
authors.lastname: Comenzo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001897:Boronic Acids / Q000008:administration & dosage; D000069286:Bortezomib; D003907:Dexamethasone / Q000008:administration & dosage; D004317:Doxorubicin / Q000008:administration & dosage; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D009367:Neoplasm Staging; D011379:Prognosis; D011719:Pyrazines / Q000008:administration & dosage; D023981:Sarcoma, Myeloid / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D015996:Survival Rate; D013792:Thalidomide / Q000008:administration & dosage
chemical_list: D001897:Boronic Acids; D011719:Pyrazines; D013792:Thalidomide; D000069286:Bortezomib; D003907:Dexamethasone; D004317:Doxorubicin