Is VTD the Best First Line Therapy for Multiple Myeloma in an Environment with Limited Resources? an Analysis of Outcomes and Costs

INTRODUCTIONAutologous hematopoietic stem cell transplantation (auto-HSCT) prolongs the progression free survival of patients with multiple myeloma (MM). Currently there are multiple treatment regimens for MM, however, in an environment of limited resources, it is essential to implement an adapted treatment plan to reduce costs and increase accessibility. We aim to compare the cost of auto HSCT and thalidomide maintenance with other treatment strategies.

MATERIAL AND METHODS

This was a retrospective observational study performed in a University Hospital in Mexico. Patients with MM treated between 2017 and 2019 with 4 cycles of VTD (Bortezomib, thalidomide, dexamethasone) followed by auto-HSCT and maintenance with thalidomide were included. The cost of auto- HSCT was analyzed as well as the VTD, KRD, VRD and Dara-VTD schemes. Progression-free and overall survival (PFS and OS) of the auto- HSCT group were compared with data published in the literature for the different treatment schedules.

RESULTS 44 consecutive patients with MM were included, with a median age of 57 years (range, 39-70). Thirty patients were women (68.20%) and fourteen patients were men (31.80%). One half of all patients (50%) had Durie Salmon stage I disease, (22.72%) had stage II and (27.27%) had stage II, at the time of auto- HSCT: was complete response in 10 patients (22.70%) very good partial response in n=26 (59.10%) and a partial response in n=8 (18.20%). All patients proceeded to auto-transplant. Conditioning was melphalan 200 mg/m2 in n=35 (79.5%). OS at day +100 was 97.7% (43 patients) and progression-free survival was 76.7% at 60 months.

Regarding the status of the MM at day +100 was in these 43 patients, with a median follow-up of 30 months (range: 3-60), currently 33 patients (76.7%) patients are in complete response, 1 (2.3%) in partial response), 4 (9.3%) in relapse and 5 (11.6%) died from non relapse mortality (acute myocardial infarction, stroke, heart failure)

The median time to relapse was 33.5 (3-60) months. The cost of auto- HSCT was $5,800 USD. Table 1 compares the costs of 4 induction cycles with usual scheme

CONCLUSIONS The response with VTD followed by auto-HSCT and maintenance with thalidomide are comparable in overall and progression-free survival with more expensive schemes such as KRd, VRd and Dara-VTd with lower cost.

Key words: stem cell trasplantation, multiple myeloma, cost, limited resource

No relevant conflicts of interest to declare.