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    Treatment of Newly Diagnosed Myeloma (excluding t-cell redirection therapy)

    Category: Treatment of Newly Diagnosed Myeloma (excluding t-cell redirection therapy)

    Effects of Two Bortezomib-Based Protocols (VCD and VRD) on Responses and Survival as Induction Treatment of Patients with Multiple Myeloma Eligible for Autologous Stem Cell Transplantation

    (PA-397) Effects of Two Bortezomib-Based Protocols (VCD and VRD) on Responses and Survival as Induction Treatment of Patients with Multiple Myeloma Eligible for Autologous Stem Cell Transplantation

    Friday, September 19, 2025

    Introduction:      In patients diagnosed with multiple myeloma (MM) who are eligible for autologous stem cell transplantation (ASCT) current guidelines recommend the VRD regimen (bortezomib, lenalidomide, dexamethasone) as the preferred triplet induction therapy, while VCD (bortezomib, cyclophosphamide, dexamethasone) is considered as an alternative. Some studies comparing these regimens demonstrated superior response rates and survival with VRD, whereas others have found no significant difference. This study was conducted to compare the real world data of VRD and VCD induction regimens in terms of response, survival and side effects in newly diagnosed ASCT-eligible MM patients.

    Methods:   Data from 133 MM patients who had been treated at our center between January 2015 and October 2023 were examined retrospectively. All patients were newly diagnosed and ASCT-eligible and received either VCD or VRD as initial therapy. Information on demographics, laboratory results, imaging, pathology, response, survival, side effects was recorded and analysed.

    Results:   Of the 133 patients (57,1% male, median age 57), 73 received VCD, 20 received VRD and 40 patients had been treated with VRD following initial VCD. Patients were analyzed as three separate groups. Baseline characteristics were largely comparable across groups. The VRD group had a shorter follow up period and a higher proportion of ISS stage I patients, although R-ISS, R2-ISS and cytogenetic risk were similar between groups. End-of-induction treatment response rates of partial response (PR) and above were higher following VRD regimen compared to VCD  (%97 vs %82) (p< 0.05). Post-transplantation day 100 responses were also better in the VRD group but the difference was not statistically significant (p >0.05). In the survival analysis, overall survival was significantly better with VRD compared to VCD (median survival not reached vs 115,8 months) while no significant difference in progression free survival was detected. Among patients receiving maintenance therapy, VRD induction didn’t confer a survival advantage (p >0.05). In multivariate analysis, including high cytogenetic risk, maintenance treatment and ISS, no significant survival difference was observed between induction treatment groups. Adverse event profiles were comparable across groups. Additionally in our cohort, once-weekly bortezomib administration when compared to twice-weekly bortezomib administration (73 vs 29 patients, respectively) was associated with fewer neuropathy and didn’t result in lower responses and survival. Also R2-ISS differentiated survival among patients better than ISS and R-ISS; PET responses were independently associated with survival. 

    Conclusions:   In this real world cohort, VRD provided better response rates and overall survival in univariate analysis, but no significant survival difference was detected between induction regimens in multivariate analysis among confounding factors such as maintenance and cytogenetic risk. Both regimens had similar side effect profiles.