Bortezomib-Based Triplet Therapy As First Line Treatment in Newly Diagnosed Multiple Myeloma Patients in Perú

Introduction

Standard treatment in multiple myeloma is based on triplet and more recently in quadruplet therapy, with lenalidomide being the preferred immunomodulatory drug, however in low-and middle-income countries novel therapies are not readily available. Bortezomib-based triplet is the standard treatment in Peru. We aimed to determine the outcomes with the different combinations of bortezomib.

Methods

We retrospectively reviewed medical records of patients with newly diagnosed multiple myeloma (MM) treated at 5 institutions from Perú including the National Cancer Institute (public institution) and Oncosalud-AUNA (private institution). Patients with MM who received bortezomib-based triplet therapy from 2017 to 2023 were included for the analysis. Smoldering MM and plasma cell leukemia were excluded. Baseline characteristics were evaluated, and overall survival was analyzed using STATA program.

Results

During the period of study 164 patients were included. The median age was 59 (range 30-83). Most were male (60%). Ig G subtype was seen in 61% of cases, followed by Ig A (24%) and light chain myeloma (14%). Non-secretor myeloma accounts for 1% of cases. According to ISS classification ISS I, ISS II, ISS III and unknown were 34%, 21%, 40% and 5%, respectively. 75% were eligible for transplant. However, only 46% of the entire cohort underwent autologous transplantation, all patients with VRd received transplant. 91% (149) received VTd, 8% (14%) VRd and only 1% VCd. 150 patients had evaluation of the treatment response, the overall response rate (ORR) was 83%, complete response + strict complete response was obtained in 43%, followed by very good partial response in 30% of and partial response in 13%. Cytogenetics risk stratification was not available due to the lack of FISH. The median follow-up was 23 months (range 1 -122m). The median overall survival for the entire cohort was not reached (IQR 80-NR). The 5-y OS was 79.5% (95 IC, 71.2-85.6). The 5y OS for the VTd group was 77% and 100% for the VRd group.

Conclusion

Bortezomib-based triplet therapy is highly effective in patients with newly diagnosed multiple myeloma more than the published in international reports. Most patients used VTd as first line treatment. Three-quarters of patients were eligible for transplant. However less than half actually received transplant. Overall survival is good being 100% at 5 years for the VRd group compared to 77% for the VTd group, although seems that the benefit is due to the transplant for the VRd group. The lack of the availability FISH test is very important to stratify our patient to give a better treatment.

No relevant conflicts of interest to declare.