Results of the protocol VCD for Multiple Myeloma in a single center in Algeria

Background: For elderly patients with multiple myeloma (MM), the toxicity of bortezomib (BTZ)-based regimen interrupts regimen adherence and many patients should discontinue BTZ-based regimen. Therefore, the current study explored the outcomes between frontline BTZ-based and non-BTZ regimen for elderly patients with MM, and those of frontline and salvage BTZ-based regimen. Methods: This study retrospectively analyzed the outcomes of 93 elderly patients with MM diagnosed from 2007 Mar to 2015 Mar. To evaluate the effects of toxicity and adherence of frontline BTZ-based regimen on long-term outcomes, failure free survival (FFS) were analyzed. FFS was defined as time from initiation of treatment to treatment failures such as 1) progression or death during treatment, 2) discontinuation for side effect (SE), and 3) regimen change for insufficient efficacy. Results: Median age was 71 years (range 65-87) and 56 patients (60.2%) were male. ISS risk groups were stage I in 8 patients (8.6%), II in 40 (43.0%), and II in 45 (48.4%). Frontline BTZ-based regimen was performed in 24 patients (25.8%) and non-BTZ regimens in 69 (74.2%). Median cycles of frontline regimens were 3.5 cycles (range 1-9 cycles) in BTZ-based regimen and 6 cycles (range 1-77) in non-BTZ regimens. The median follow-up duration was 393 days (range 52-1406 days) and 470 days (range 58-2536 days) in frontline BTZ and nonBTZ group. The 3-year overall survival (OS) rates were not different between two groups: 46.3 13.9% in BTZ-based regimen and 50.8 7.8% in non-BTZ regimens (p1⁄40.629). Treatment failure was occurred in 13 patients (54.2%) and 42 (60.9%) in BTZ and non-BTZ regimens, respectively. The major causes of treatment failures were discontinuation for SE in frontline BTZ regimen (n1⁄410, 76.9%) and regimen change in non-BTZ regimen (n1⁄421, 50.0%). FFS was 41.2 11.5% and 39.4 6.1% in BTZ and nonBTZ regimens (p1⁄40.808). In the multivariate analysis, frontline BTZ based-regimen showed higher response rates ( PR) (HR 3.875, p1⁄40.024), but did not show favorable long-term survival rates (HR 1.203, p1⁄40.650) compared to non-BTZ regimens. Conclusion: Frontline BTZ-based regimen showed higher response rate than frontline non-BTZ regimens. However, treatment failure for SE was significantly high in frontline BTZ-based regimen. The similar long-term survival rates may reflect that the following regimens after failure to frontline therapy in non-BTZ group successfully salvaged those patients.