A cohort study comparing the efficacy and safety of bortezomib plus dexamethasone versus bortezomib, epirubicin and dexamethasone in patients with multiple myeloma / 中华内科杂志

ABSTRACT

Objective Bortezomib plus dexamethasone (BD) and bortezomib,epirubicin plus dexamethasone (PAD) are both front-line regimens of multiple myeloma.This study aimed to assess the efficacy and safety of BD versus PAD regimens in multiple myeloma.Methods All 208 patients with newly diagnosed multiple myeloma using either BD or PAD front-line regimens were enrolled between November 2006 and July 2014.Front-line chemotherapy regimens were 2-7 cycles.Response rates,overall survival,progression-free survival,and adverse effects were retrospectively analyzed.Results (1) In PAD group,the overall response rate was 82.9％ [complete response(CR) 28.6％,very good partial response(VGPR) 12.9％],which was similar as that in BD group [70.3％ (CR 26.8％,VGPR 5.1％),P =0.049].The estimated median progression-free survival was 34.0 months in PAD group versus 25.0 months in BD group (P =0.010).(2) The triplet regimen has a higher accumulated response rate along with chemotherapy cycles,but it didn't show any difference with the doublet regimen.(3) In elderly patients (＞ 65 years old),the overall response rates in two groups had no significant difference (P =0.769),while in patients ≤65 years old,PAD regimen were more effective than BD regimen (P =0.037).(4) Grade 3 and 4 adverse events were recorded with a higher number of patients in the PAD group than those in the BD group.Conclusions Compared with BD regimen,PAD regimen improves the initial response rates,especially deep responses,as well as progression-free survival in patients with newly diagnosed multiple myeloma.However,more severe toxicities are accordingly higher.In elderly patients,overall response rate,estimated median progression-free survival,and median overall survival are all comparable in both regimens.