Journal
LEUKEMIA & LYMPHOMA
Volume 53, Issue 2, Pages 275-281Publisher
INFORMA HEALTHCARE
DOI: 10.3109/10428194.2011.606943
Keywords
Multiple myeloma; sequential therapy; extramedullary; bortezomib; renal failure
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Funding
- Centocor Ortho Biotech L.L.C. (Johnson & Johnson Pharmaceutical Research L.L.C.)
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We evaluated sequential bortezomib, liposomal doxorubicin and dexamethasone (BDD) followed by thalidomide and dexamethasone (TD) if >= partial response (PR) or bortezomib and TD (BTD) if < PR in untreated patients with multiple myeloma with International Staging System stage II/III or extramedullary disease. Of the 42 patients enrolled, two-thirds had cytogenetic abnormalities including high-risk findings [del(13q) by karyotype, t(4;14), loss of p53 or gain 1q] in one-third. After the planned three cycles of BDD, the overall response rate (ORR) was 81% with 40% >= very good partial response (VGPR), including 26% near complete and complete responses (nCR/CR). After the additional two cycles of TD or BTD, ORR was 83% with 60% >= VGPR including 43% nCR/CR, indicating deeper responses following sequential therapy (p = 0.008). Two-thirds of patients who presented with significant renal impairment had improved renal function. All patients undergoing stem cell harvest had a successful collection. BDD followed by TD or BTD is effective initial therapy for this population with higher-risk myeloma and results in rapid disease control and a high response rate.
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