Combination of Bortezomib, Dexamethasone, Thalidomide and Zoledronic Acid (VdtZ) Results in a High Rate of Complete Response in High-Risk Non-Hodgkin Lymphoma

We previously reported that the combination of low-dose dexamethasone (d) and thalidomide (t) with higher frequency zoledronic acid (ZOMETA, Z) – the “dtZ” regimen – was associated with an overall response rate (RR) of 75.0% in patients with relapsed/refractory multiple myeloma (MM). However, the rate immunofixation (IF)-negative complete reponses (CR) was only 7.7%. In those patients who did not achieve CR, addition of bortezomib (VELCADE, V) to “dtZ” – the “VdtZ” regimen – greatly improved the overall RR to 92.9% and CR to 42.9%. In addition, 21.4% of “dtZ/VdtZ”-treated patients also achieved near-CR (nCR). Amongst 14 consecutive newly-diagnosed patients with MM who were treated with “dtZ/VdtZ”, the RR was 100% and CR/nCR was >75%. Encouraged by these data in MM, we applied the 3-weekly “VdtZ” regimen – intravenous Vel 1.5 mg/m² days 1, 4, 8 and 11; oral Dex 20 mg days 1, 8 and 15; oral Thal 100 mg days 1–21; and intravenous Zol 4 mg day 1 – in 3 consecutive patients with newly-diagnosed high-risk, difficult-to-treat non-Hodgkin lymphoma (NHL) to determine the feasibility of using “VdtZ” to treat NHL. The patient characteristics and results are summarized in the table below:

In summary, all 3 (100%) patients rapidly reported CR upon initiation of “VdtZ. Although significant tumor lysis was reported in all patients, treatment was fairly welltolerated. These data provide a basis for further studies on the “VdtZ” regimen for the treatment of high-risk NHL.