Clinical Experience and Prognostic Factors with Bortezomib-Combined Regimen in 40 Patients with Multiple Myeloma

To explore the medical effects, prognostic factors relating to the effects and side effects of bortezomib-combined regimen in treatment of multiple myeloma (MM), and evaluate the safety of this regimen in patients with special conditions.

Methods: Forty newly diagnosed and relapsed or refractory MM treated with the regimen of combination of bortezomib and dexamethasone in a cycle of 3 weeks. All of the patients received a median of 3 (1–9) cycles of the treatment. Response to bortezomib was evaluated according to the criteria of the European Group for Blood and Marrow Transplantation (EBMT) and adverse events were graded according to the National Cancer Institute Common Toxicity Criteria.

Results: Total response rate was 75.0% (30/40), and the rate of CR+nCR was 42.5% (17/40). Eighty percent patients (24/30) showed effects after the first cycle, although the median time of best effect was 2 cycles. Compare to the other types, light-chain type had higher total response rate (100.0% vs. 65.5%, P=0.038)and CR rate (36.4% vs. 6.9%, P=0.039), and also responded earlier with 81.8% (9/11) patients reached the best effect after the first cycle. The factors which showed no relationship to the effects were age (<65 years vs. >65 years, P=0.081), sex (P=0.696), DS staging (P=1.0), ISS staging(P=0.969), newly or retreated (P=0.731), using thalidomide or not(P=0.338), renal function damage or not(P=0.401), PLT level(P=1.0), hypercalcemia or not(P=0.306), Hb level(P=0.70)and the ratio of tumor cells in bone marrow(P=0.693). Grade III~IV adverse effects in this VD regimen was low, including leucocytopenia, thrombocytopenia, diarrh ea and debility, could be relieved by symptomatic treatment or delay the chemotherapy. The rate of infection was high and which was one of the important cause of death. Renal function improvement could be showed in all of the 10 patients who had renal inadequacy, and compared with normal patients, the incidences of side and adverse effects had no statistical differences.

Conclusion: The Bortezomib combination regimen has significant effect in MM treatment. It shows more significant in light-chain type patients, and show earlier effect onset. This regimen can be tolerant in most patients, and is also safe in patients with renal inadequacy.