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 Table of Contents  
ORIGINAL ARTICLE
Year : 2015  |  Volume : 40  |  Issue : 4  |  Page : 175-176

VTD in newly diagnosed myeloma: an institutional experience


Department of Hematology, Nil Ratan Sircar Medical College and Hospital, Kolkata, West Bengal, India

Date of Submission04-May-2015
Date of Acceptance23-Jun-2015
Date of Web Publication23-Nov-2015

Correspondence Address:
Meet Kumar
DM (Clin Hematology), Department of Hematology, Nil Ratan Sircar Medical College and Hospital, Kolkata - 700 014, West Bengal
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1110-1067.170202

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  Abstract 

Background Myeloma management has evolved over the years with logarithmic expansion of available treatment options. The treatment algorithms are also changing because of the better responses obtained with newer agents. Bortezomib, thalidomide and dexamathasone (also known as VTD) is one such therapy that has shown improved long term outcomes.
Materials and methods We conducted a single-center, retrospective analysis of all myeloma patients treated with VTD chemotherapy.
Results An overall response achieved was 85.7% with 40% CR.
Conclusion We conclude VTD is an effective chemotherapy regimen in newly-diagnosed myeloma patients.

Keywords: chemotherapy, myeloma, VTD


How to cite this article:
Kumar M, Panigrahi A, Dolai TK, De R, Mandal PK, Chakrabarti P. VTD in newly diagnosed myeloma: an institutional experience. Egypt J Haematol 2015;40:175-6

How to cite this URL:
Kumar M, Panigrahi A, Dolai TK, De R, Mandal PK, Chakrabarti P. VTD in newly diagnosed myeloma: an institutional experience. Egypt J Haematol [serial online] 2015 [cited 2020 Jan 18];40:175-6. Available from: http://www.ehj.eg.net/text.asp?2015/40/4/175/170202


  VTD in newly diagnosed myeloma: an institutional experience Top


Myeloma management has evolved over the years with the logarithmic expansion of available treatment options. This has prompted the International Myeloma Working Group to propose new diagnostic criteria recently and has included major revisions in clinical, laboratory, and imaging criteria [1] . The treatment algorithms are also changing because of the better responses obtained with newer agents. Although the debate between 'cure versus control' in myeloma continues, recent treatment algorithms have recommended aggressive multiagent chemotherapy for transplant-eligible as well as transplant-ineligible patients [2] . A combination treatment with bortezomib, thalidomide, and dexamethasone (also known as VTD) is one such therapy that has shown improved long-term outcomes.

We conducted a single-center, retrospective analysis of all myeloma patients treated with VTD chemotherapy. The primary endpoint was response assessment (as per the International Working Group criteria) and secondary endpoints were safety and overall survival. All newly diagnosed patients of multiple myeloma (diagnosed June 2011 to June 2013) who received VTD as induction therapy for at least six cycles were eligible for the study. The study doses comprised (i.e. one cycle of VTD) bortezomib (1.3 mg/m 2 slow intravenous weekly, four times), thalidomide (100 mg/day if absolute neutrophil count>1500/mm 3 ), and dexamethasone (40 mg weekly, orally). Other medications included were (but not restricted to) bisphosphonates (zoledronic acid), antithrombotic prophylaxis (aspirin), and antiviral prophylaxis (acyclovir).

A total of 37 patients were eligible. Details of the baseline characters of the patients are presented in [Table 1]. Of these 37 patients, two patients died during induction due to infective complications (at a median follow-up of 4 months after starting therapy). Of the remaining 35 patients who completed six cycles of VTD therapy, 18 patients received thalidomide maintenance, five patients underwent consolidation with autologous stem cell transplantation, and the remaining 12 patients did not receive any postinduction therapy due to personal reasons. These postinduction treatment decisions were based on patient preferences after uniform counseling. At the end of six cycles of induction, 40% of patients (14/35) achieved complete response, 25.7% (9/35) achieved very good partial response, 20% achieved partial response (7/35). and another 14.3% had stable disease (5/35). At a median follow-up of 18.2 months (range 8-43 months), 83.3% of patients (15/18 patients) in the thalidomide maintenance group, 100% of patients (5/5 patients) in the autologous stem cell transplantation group, and 67% of patients (8/12 patients) in the observation group were disease-free ([Figure 1]).
Figure 1 Postinduction therapy in all patients and their outcomes. Auto SCT, autologous stem cell transplantation.

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Table 1 Baseline characteristics of all patients


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The major toxicities encountered were nonhematological and included constipation (40.5%), peripheral neuropathy (total 43.2%, grade IV 2.7%), and infections (29.7%). Hematological toxicities included neutropenia (grade I 18.9%), thrombocytopenia (grade I 18.9%), and thrombosis (13.5%). The overall survival at 22 months was 80.7% and relapse-free survival at 18 months was 75% ([Figure 2]).
Figure 2 Kaplan-Meier curves showing overall survival and relapse-free survival for all patients

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VTD combination is an effective chemotherapy regimen. In one of the earlier studies by Wang et al. [3] , VTD regimen showed 87% overall remission with 16% of patients achieving complete response. Studies by PETHEMA have also established superiority of VTD regimen over more aggressive therapies in achieving complete remissions (preautologous and postautologous transplantation) and prolonging progression-free survival [4] . We observed similar results as well, with an overall response of 85.7% and 40% of patients achieving complete response. We found no major differences in the outcomes of patients who received either thalidomide maintenance or underwent autologous stem cell transplant, but that may possibly reflect the small sample size in the study. We conclude that VTD is an effective chemotherapy regimen in newly diagnosed myeloma patients.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Rajkumar SV, Dimopoulos MA, Palumbo A, Blade J, Merlini G, Mateos MV, et al. International Myeloma Working Group updated criteria for the diagnosis of multiple myeloma. Lancet Oncol 2014; 15 :e538-e548.  Back to cited text no. 1
    
2.
Rajkumar SV. Multiple myeloma: 2014 update on diagnosis, risk-stratification, and management. Am J Hematol 2014; 89 :999-1009.  Back to cited text no. 2
    
3.
Wang M, Giralt S, Delasalle K, Handy B, Alexanian R. Bortezomib in combination with thalidomide-dexamethasone for previously untreated multiple myeloma. Hematology 2007; 12 :235-239.  Back to cited text no. 3
    
4.
Rosinol L, Oriol A, Teruel AI, Hernandez D, Lopez-Jimenez J, de la Rubia J, et al.Programa para el Estudio y la Terapéutica de las Hemopatías Malignas/Grupo Español de Mieloma (PETHEMA/GEM) group. Superiority of bortezomib, thalidomide, and dexamethasone (VTD) as induction pretransplantation therapy in multiple myeloma: a randomized phase 3 PETHEMA/GEM study. Blood 2012; 120:1589-1596.  Back to cited text no. 4
    


    Figures

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