Comparison of Cyclophosphamide–Thalidomide–Dexamethasone to Bortezomib–Cyclophosphamide–Dexamethasone as Induction Therapy for Multiple Myeloma Patients in Brazil

• Published in: Hematology/oncology and stem cell therapy 2017-09, Vol.10 (3), p.135-142
• Main Authors: Vigolo, Suelen, Zuckermann, Joice, Isabel Bittencourt, Rosane, Silla, Lúcia, André Pilger, Diogo
• Format: Article
• Language: English
• Subjects: Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Bortezomib - therapeutic use; CTD; Cyclophosphamide - therapeutic use; Dexamethasone - therapeutic use; Female; Hematology, Oncology and Palliative Medicine; Humans; Induction Chemotherapy - methods; Male; Middle Aged; Multiple myeloma; Multiple Myeloma - drug therapy; Multiple Myeloma - pathology; Retrospective Studies; Thalidomide - therapeutic use; VCD
• ISSN: 1658-3876
• DOI: 10.1016/j.hemonc.2017.05.027

Abstract Objective/Background Chemotherapy followed by autologous hematopoietic stem cell transplantation (HSCT) remains the standard treatment for multiple myeloma (MM). Thalidomide or bortezomib may be combined with cyclophosphamide and dexamethasone, in what are known as the CTD and VCD protocols, respectively. The objective of this study was to evaluate the clinical characteristics and response rates obtained with CTD and VCD, observing whether the inclusion of bortezomib to treat MM patients in Brazil increases therapeutic efficiency. Methods Forty-three MM patients treated with induction protocols CTD and VCD between January 2010 and March 2015 were included. The parameters analyzed were staging, frequency of comorbidities prior to treatment, response rates obtained at each induction cycle, progression-free survival, and overall survival of patients. Results Very good partial response and complete response obtained with the VCD protocol were superior, compared with the CTD treatment. The presence of comorbidities was similar in the two groups, except kidney failure, which prevailed in the VCD group. Also, 78.3% and 48.3% of patients treated with the VCD and CTD protocols underwent autologous HSCT, respectively. In patients given the VCD protocol, 45.5% had complete response before autologous HSCT. Among those given CTD, this number was only 7.1% ( p = .023). Disease progression after autologous HSCT did not differ between the two groups. Conclusion VCD afforded better responses than the CTD protocol, and improved patient condition before autologous HSCT. However, more studies are necessary including more patients and addressing various clinical conditions, besides the analysis of cost-effectiveness of these treatments.