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. 2019 May 3;36(2):106-111.
doi: 10.4274/tjh.galenos.2019.2019.0306.

Dose Adjustment Helps Obtain Better Outcomes in Multiple Myeloma Patients with Bortezomib, Melphalan, and Prednisolone (VMP) Treatment

Su-Hee Cho  1 , Ho-Jin Shin  1 , Ki Sun Jung  1 , Do Young Kim  1
Affiliations

Dose Adjustment Helps Obtain Better Outcomes in Multiple Myeloma Patients with Bortezomib, Melphalan, and Prednisolone (VMP) Treatment

Su-Hee Cho et al. Turk J Haematol. .

Abstract
in English, Turkish

Objective: Multiple myeloma (MM) has a better survival outcome because of the development of drugs. However, equivalent outcomes cannot be expected from the same drug. Therefore, how the treatment schedule is managed is important. We analyzed VMP (bortezomib, melphalan, and prednisolone) data to determine an effective treatment strategy.

Materials and methods: We collected the data of 59 patients who were newly diagnosed with MM from January 2012 to April 2017 using electronic medical records. We analyzed baseline characteristics, responses, dose reductions, and survival.

Results: The overall response rate was 86.5% [complete response (CR): 32.2%, very good partial response (VGPR): 37.3%]. The median progression-free survival was 33.6 months and the 5-year overall survival rate was 70%. There were significant better progression-free survival outcomes between CR and non-CR for each of the 4 cycles. Of the four patients who achieved CR after the first cycle, none have had disease progression as of yet. We divided patients into two groups according to the median dose (52.1 mg/m2) and we found no differences between the high-dose and low-dose groups. About 78% of patients completed 9-cycle schedules and 84% patients experienced dose reduction, mostly for reasons of non-hematologic toxicities.

Conclusion: Active dose reduction helped to continue treatment and it increased the opportunity to be exposed to drugs. In the end, it resulted in improved outcome.

Amaç: Günümüzde yeni geliştirilen ilaçlar sayesinde multiple myelom (MM) hastalarında tedavi sonuçları daha iyidir. Ancak, aynı ilaç için her hastada eşit sonuçlar elde edilmesi beklenemez. Bu nedenle, tedavi şemalarının nasıl düzenlendiği büyük önem taşımaktadır. Biz VMP (bortezomib, melfalan ve prednizolon) tedavi verilerini etkin tedavi stratejisi belirlemek amacıyla inceledik.

Gereç ve yöntemler: Ocak 2012’den Nisan 2017’ye kadar yeni tanı almış 59 MM hastalarının elektronik dosyaları incelendi. Tedavi öncesi özellikler, tedavi cevapları, doz azaltımları ve sağkalımları analiz edildi.

Bulgular: Tüm yanıt oranı %86,5 [tam yanıt (TY) %32,2; çok iyi parsiyel yanıt %37,3) idi. Medyan progresyonsuz yaşam 33,6 ay ve 5 yıllık genel sağkalım %70 idi. Her 4 siklus için de TY sağlanan hastalarda medyan progresyonsuz yaşam TY sağlanamayan hastalara göre istatistiksel olarak anlamlı düzeyde daha iyiydi. İlk siklus sonrasında TY sağlanmış olan 4 hastanın hiçbirinde şu ana kadar progresyon izlenmedi. Hastaları median doza göre (52,1 mg/m2) ikiye ayırdığımızda düşük ve yüksek dozda ilaç alanlar arasında fark izlenmedi. Hastaların yaklaşık %78’i planlanan 9 siklusu tamamladı ve %84’ü genellikle hematolojik olmayan toksisiteye bağlı olarak doz azaltılması gerektirdi.

Sonuç: Aktif doz azaltılması, tedavinin devamının sağlanmasına yardım etmekte ve ilaçlara maruziyetinin artmasına fırsat tanımaktadır. Sonuç olarak da daha iyi tedavi sonuçları sağlamaktadır.

Keywords: Multiple myeloma; Bortezomib; Melphalan; Prednisolone.

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Conflict of interest statement

Conflict of Interest: The authors of this paper have no conflicts of interest, including specific financial interests, relationships, and/or affiliations relevant to the subject matter or materials included.

Figures

Figure 1
Figure 1
Progression-free survival according to presence of complete response. CR: Complete response.
Figure 2
Figure 2
Progression-free survival and overall survival according to very good partial response or partial response. VGPR: Very good partial response, PR: partial response.
Figure 3
Figure 3
Progression-free survival and overall survival according to median dose.
See this image and copyright information in PMC

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