1Russian Research Institute of Hematology and Transfusiology, 2City Hospital 15, St. Petersburg 3St. Petersburg State Pavlov Medical University, 4City Hospital 31, 5Irkutsk Region Clinic Hospital, 6Irkutsk State Medical University, 7Department of Hospital in station Smolensk, 8Road Clinic Hospital, St-Petersburg
We report the activity bortezomib retreatment in relapsed or refractory multiple myeloma patients. We used bortezomib+dexamethasone (VD), VD+cyclophosphamide (CVD), bortezomib+MP (VMP) and bortezomib+dexamethasone+doxorubicin (PAD) in 130 patients with relapsed and refractory myeloma. The patients had a median age of 67 years (range, 38-80 years). For patients who received bortezomib retreatment the overall response rate was 71%. Complete response (CR) and near complete response (n-CR) rate (based on EBMT criteria) was 40 percent. For patients who received VD the overall response rate was 65.5%. 19.5% patients achieved CR (CR+n-CR). For patients who received CVD, VMP and PAD the overall response rate was 71.5%, 72% and 83.5%, respectively. After a median follow-up of 4-70 months, median overall survival (OS) was not reached. Median event-free survival was 18 months. The effects of VD, CVD and VMP were compared to PAD in our trial. PAD treatment resulted in a significant increase in OS (p<0.05). Side effects were predictable and manageable. The most common adverse events reported were asthenia (53%), neuropathy (54.6%), thrombocytopenia (25.4%), anemia (22.3%). Serious adverse events were rare. Bortezomib retreatment is a safe and effective treatment for relapsed or refractory multiple myeloma.
1. Kyle R. A., Rajkumar S. V. Multiple myeloma// Blood. 2008. Vol. 111, N. 6. P. 2962-2972.
2. Bessmelcev S.S., Stelmashenko L.V., Karyagina E.V. i dr. Bortezomib v terapii 1- i linii pri lechenii mnojestvennoi mielomi // Rossiiskie medicinskie vesti. – 2009. – T. XIV, №4. – S. 29-37.
3. Bessmelcev S.S., Karyagina E.V., Stelmashenko L.V i dr. Bortezomib (Velkeid) v kombinacii s deksametazonom v lechenii refrakternih/recidiviryushih form mnojestvennoi mielomi. Rezyltati zakluchitelnogo analiza// Klinicheskaya Onkogematologiya. – 2009. – T. 2, №3. – S. 236-244.
4. Bessmelcev S.S., Stelmashenko L.V., Stepanova N.V. i dr. Bortezomib (velkeid) i melfalan s prednizolonom v lechenii mnojestvennoi mielomi y pojilih bolnih// Onkogematologiya. – 2010. - №2. – S. 40-45.
5. Wolf J., Richardson P.G, Schuster M. et al. Utility of bortezomib retreatment in relapsed or refractory multiple myeloma patients: a multicenter case series// Clinical Advances in Hematology & Oncology. - 2008. - Vol. 6. - P. 755-759.
6. Hrusovsky I., Emmerich B., Enhgelhardt M. et al. Response to bortezomib retreatment is determined by duration of preceding treatment free interval – results from a retrospective multicenter survey// Haematologica. - 2008. - Vol. 93, Suppl. 1. - P. 259 (Abstr. 0645).
7. Blade J., Samson D., Reece D. et al. Criteria for evaluating disease response and progression in patients with multiple myeloma treated by high-dose therapy and haemopoietic stem cell transplantation// Br. J. Haematol. - 1998. - Vol. - 102. - P. 1115-1123.
8. Bessmelcev S.S., Karyagina E.V., Stelmashenko L.V. i dr. Chastota, harakteristika i metodi lecheniya perifericheskoi neiropatii y bolnih mnojestvennoi mielomoi, polychaushih bortezomib (velkeid)//Onkogematologiya. - 2008. - №3. - S. 52-62.
9. Facon T., Menard J.F., Michaux J.L. et al. Prognostic factors in low tumor mass asymptomatic multiple myeloma: a report on 91 patients. The Group d’Etudes et de recherche sur le Myeloma// Am. J. Hematol. - 1995. - Vol. 48. - P. 71 – 75.
10. Rodon P., Linassier C., Gauvain J.B. et al. Multiple myeloma in elderly patients: presenting features and outcome// Eur. J Haematol. - 2001. - Vol. 66. - P. 11 – 17.