Induction Therapy with Bortezomib-Cyclophosphamide-Dexamethasone (BCD) for Newly Diagnosed Transplant Eligible Patients with Multiple Myeloma

Although novel agents improved the outcome of patients with multiple myeloma (MM), only bortezomib (Bor) is available for newly diagnosed patients in Japan. We have started induction therapy with bortezomib-cyclophosphamide-dexamethasone (BCD) for newly diagnosed MM (NDMM) patients since Nov. 2011. Here we report the efficacy and the feasibility of this induction therapy for transplant eligible NDMM. Twenty-nine patients received BCD as induction therapy between Nov. 2011 and Nov. 2013 in our institute. BCD is composed of CPA 300mg/m² po, Bor 1.3mg/m² iv or sc, and Dex 40mg/body po on day 1, 8, 15, and 22 with 28 days cycle. Median age was 55 (range 31-67), M/F 18/11, IgG/IgA/IgE/BJ 13/7/1/8, and ISS I/II/III 14/10/5. Eight out of 29 had t(11;14) and 2 had t(4;14). Median cycles of BCD were 4 (range 2-6), except for one patient who progressed during first cycle. Grade 4 neutropenia (<500/μL) was observed in 2 patients and no grade 2 thrombocytopenia (<75K/μL) was observed. Grade 3 non-hematologic adverse event was observed in one patient with varicella-zoster virus reactivation. Response after BCD was sCR 6, CR 0, VGPR 9, PR 6, MR 3, SD 3, PD 2 (≥PR 72%, ≥VGPR 52%, and sCR 21%). Two years progression free survival (PFS) was 78.3% (95% CI: 54.7-90.6). Autologous stem cell harvest was performed in 27 patients. Seventeen of 27 patients received high dose melphalan and ASCT immediately (“upfront” group), while other 10 patients were scheduled for no ASCT until PD (“late” group). Maximal response was ≥PR 94%, ≥VGPR 76%, ≥CR 65%, and sCR 59% in “upfront” group, and ≥PR 90%, ≥VGPR 60%, ≥CR 50%, and sCR 40% in “late” group. Two and one patients have diagnosed as PD in “upfront” group and “late” group, respectively. Two years PFS in “upfront” group was 82.1% (95%CI: 44.4-95.3). Although follow up period is still short, there was no difference in OS and PFS between two groups. Our data suggest the efficacy and the feasibility of BCD for transplant eligible NDMM, but longer follow up is needed.