Frontline Management of Myeloma with Bortezemib and Dexamethasone - Focus on Renal Failure - A Study From India

First line treatment of myeloma has witnessed significant changes and improvement in the last one decade. Bortezemib – proteasome inhibitor and lenalidomide – IMID, in combination with other drugs offers the best chances to achieve complete remission and or very good partial remission. These two agents also seem to have overcome the barrier of poor prognostic factors including 4:14 translocation, 13p deletion, renal failure.

We analysed 21 patients of multiple myeloma treated at our hospital in 2008–2009 with bortezemib and dexamethasone. Median age at presentation was 62 years. There were sixteen males and five females. IgG Kappa monoclonal spike was seen in fourteen cases. Light chains alone were seen in urine in 4 cases. Sixteen patients had renal failure. Bone involvement was seen in fifteen patients, anemia in sixteen cases. B2 microglobulin levels were >2.5mg/L in fifteen cases. As per ISS staging, thirteen patients were stage 3, six were stage 2 and two were stage 1. All patients were treated with bortezemib 1.3 mg per sq.mt and dexamethasone 40 mg day 1, 4, 8, 11. Cycles were repeated every three weeks. Four such cycles were given. Hemodialysis was done as indicated.

Complete remission (negative IFE) was seen in five, VGPR in five, PR in five, stable disease in four and progressive disease in two cases. Improvement in renal failure and independence from dialysis was seen in twelve of sixteen cases. Out of 21 cases, eight developed peripheral neuropathy – four mild to moderate and four severe painful neuropathy. In the latter four bortezemib was discontinued. Five patients developed thrombocytopenia requiring dose reduction for bortezemib. Four patients developed herpes zoster.

Bortezemib and dexamethsone combination is effective and safe in frontline management of myeloma patients especially with renal failure. Acyclovir prophylaxis should be considered for all patients and peripheral neuropathy should be closely monitored.

No relevant conflicts of interest to declare.