Real World Outcomes with VTD and CyBorD Induction Treatment for Transplant Eligible Multiple Myeloma Patients in a Latin American Country. A Retrospective Cohort Study from GAMM (Grupo Argentino de Mieloma Múltiple) in collaboration with GELAMM.
Data about treatment outcomes and toxicity in Latin America are scarce. There are differences with central countries based on access to healthcare system and socioeconomic status. Argentinean Society of Hematology recommends bortezomib-based triplets for induction treatment of transplant eligible newly diagnosed multiple myeloma patients. Most common options are CyBorD (cyclophosphamide, bortezomib and dexamethasone) and VTD (bortezomib, thalidomide and dexamethasone). Main goal of our retrospective, multicentric study was to compare very good partial response rate (VGPR) or better after induction treatment in a real-world setting in Argentina. Secondary objectives included comparison of complete response (CR) post-induction and after bone marrow transplantation, grade 3-4 adverse events (AE), progression-free survival (PFS) and overall survival (OS). 322 patients were included (median age at diagnosis: 57 years; 52% male; 28% had ISS3; 14% with high risk cytogenetics; median follow-up: 34 months). CyBorD was indicated in 74% and 26% received VTD. In VTD arm, 72.62% of patients achieved at least VGPR vs 53.36% receiving CyBorD (OR: 1.96 [95%CI: 1.08-3.57; P = 0.026] after adjusting by age, ISS, LDH and cytogenetic risk). Difference in VGPR was 19.26% (95%CI: 15-24). CR rate were 35.92% (VTD) vs 22.55% (CyBorD) (adjusted OR: 2.13 [95%CI: 1.12-4.05]). Difference in CR was 13.37% (95%CI: 9.6-17.53). AEs were more common with VTD (69.05% vs 55.46% for CyBorD; P = 0.030), especially grade 3-4 neuropathy (P = 0.005) and thrombosis (P = 0.001). Thromboprophylaxis was inadequate in 20.24% of patients. Hematological AEs were more common with CyBorD, especially thrombocytopenia (P = 0.017). PFS and OS at 24 months were not different between treatments. In this real-world setting, VTD was associated with better CR and VGPR than CyBorD. Nevertheless, CyBorD continues to be the preferred induction regimen in Argentina, based on safety profile. Frontline ASCT improves quality of responses, especially in countries with limited access to new drugs. This article is protected by copyright. All rights reserved.This article is protected by copyright. All rights reserved.