Induction and Maintenance Therapies With Bortezomib in Myeloma
Bortezomib induction and maintenance therapies seem to improve survival over classical cytotoxic agents without an increased risk of second primary malignancies. Hartmut Goldschmidt, MD, of the University Clinic Heidelberg, Germany, and colleagues reported these long-term results from the phase III HOVON-65/GMMG-HD4 trial in Leukemia.
In patients with multiple myeloma between the ages of 18 and 65, the investigators compared bortezomib before and after high-dose melphalan and autologous stem cell transplantation (PAD arm) with classical cytotoxic agents prior to and thalidomide after high-dose melphalan (VAD arm). The PAD regimen included bortezomib, doxorubicin, and dexamethasone; the VAD regimen included vincristine, doxorubicin, and dexamethasone.
After a median follow-up of 96 months, progression-free survival favored PAD versus VAD (34 vs. 28 months), with a trend toward improved overall survival as well. Also similar between the two study arms was overall survival from first relapse/disease progression (P=.85). In terms of second primary malignancies, which represent a concern as a consequence of myeloma therapy, the incidence was similar between the two treatment arms (7% each, P=.73).