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Review
. 2022 Oct;199(2):190-204.
doi: 10.1111/bjh.18295. Epub 2022 Jul 7.

Lenalidomide, bortezomib and dexamethasone induction therapy for the treatment of newly diagnosed multiple myeloma: a practical review

Georgia J McCaughan  1   2 , Sara Gandolfi  3   4 , John J Moore  1   2 , Paul G Richardson  5
Affiliations
Review

Lenalidomide, bortezomib and dexamethasone induction therapy for the treatment of newly diagnosed multiple myeloma: a practical review

Georgia J McCaughan et al. Br J Haematol. 2022 Oct.

Abstract

For patients with newly diagnosed multiple myeloma, survival outcomes continue to improve significantly: however, nearly all patients will relapse following induction treatment. Optimisation of induction therapy is essential to provide longer term disease control and the current standard of care for most patients incorporates an immunomodulatory agent and proteasome inhibitor, most commonly lenalidomide and bortezomib in combination with dexamethasone (RVD), with maintenance until progression. Historically there has been limited access to RVD as an induction strategy outside of the United States; fortunately, there is now increasing access worldwide. This review discusses the rationale for use of RVD as induction therapy and aims to provide guidance in prescribing this regimen in order to optimise efficacy while minimising the toxicities of treatment. We also highlight the increasing evidence for the utility of addition of a monoclonal antibody to the RVD backbone to deepen responses and potentially provide longer disease control.

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Conflict of interest statement

Georgia J. McCaughan reports advisory board participation and honoraria from Janssen. Paul G. Richardson reports institutional grant support from Bristol Myers Squibb/Celgene, Karyopharm, Oncopeptides AB, and Takeda; consulting fees for advisory committee service from Bristol Myers Squibb/Celgene, Karyopharm, Oncopeptides AB, GlaxoSmithKline, Janssen, Sanofi, and Takeda. Sara Gandolfi and John J. Moore have no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Kaplan–Meier estimates of progression‐free survival and overall survival comparing VRd versus Rd in SWOG S0777. CI, confidence interval; Rd, lenalidomide and dexamethasone; VRd, bortezomib, lenalidomide and dexamethasone.
FIGURE 2
FIGURE 2
Kaplan–Meier estimates of progression‐free survival and overall survival comparing KRd and VRd in ENDURANCE study. CI, confidence interval; HR, hazard ratio; KRd, carfilzomib, lenalidomide and dexamethasone; VRd, bortezomib, lenalidomide and dexamethasone.
See this image and copyright information in PMC

References

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