PMID- 32196120 OWN - NLM STAT- MEDLINE DCOM- 20200831 LR - 20200831 IS - 1099-1069 (Electronic) IS - 0278-0232 (Linking) VI - 38 IP - 3 DP - 2020 Aug TI - Real world outcomes with Bortezomib Thalidomide dexamethasone and Cyclophosphamide Bortezomib dexamethasone induction treatment for transplant eligible multiple myeloma patients in a Latin American country. A Retrospective Cohort Study from Grupo Argentino de Mieloma Multiple. PG - 363-371 LID - 10.1002/hon.2729 [doi] AB - 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 (AEs), progression-free survival (PFS) and overall survival (OS). Three hundred twenty-two 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 (odds ratio, OR: 1.96 [95% confidence interval, CI: 1.08-3.57; P = .026] after adjusting by age, ISS [International Staging System], lactate dehydrogenase levels (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). Adverse events (AEs) were more common with VTD (69.05% vs 55.46% for CyBorD; P = .030), especially grade 3-4 neuropathy (P = .005) and thrombosis (P = .001). Thromboprophylaxis was inadequate in 20.24% of patients. Hematological AEs were more common with CyBorD, especially thrombocytopenia (P = .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 autologous stem cell transplantation improves quality of responses, especially in countries with limited access to new drugs. CI - (c) 2020 John Wiley & Sons Ltd. FAU - Schutz, Natalia P AU - Schutz NP AUID- ORCID: 0000-0002-1167-7186 AD - Hospital Italiano de Buenos Aires - Servicio de Clinica Medica (Seccion Hematologia), Buenos Aires, Argentina. FAU - Ochoa, Paola AU - Ochoa P AD - Instituto Alexander Fleming - Departamento de Hematologia, Buenos Aires, Argentina. FAU - Duarte, Patricio AU - Duarte P AD - CEMIC - Seccion Hematologia, Buenos Aires, Argentina. FAU - Remaggi, Guillermina AU - Remaggi G AD - FUNDALEU - Departamento de Trasplante de Medula osea, Buenos Aires, Argentina. FAU - Yantorno, Sebastian AU - Yantorno S AD - Hospital Italiano de La Plata - Servicio de Hematologia (Unidad de Trasplante de Medula osea), Buenos Aires, Argentina. FAU - Corzo, Ariel AU - Corzo A AD - Hospital de Clinicas "Jose de San Martin" - Departamento de Clinica Medica (Division Hematologia), Buenos Aires, Argentina. FAU - Zabaljauregui, Soledad AU - Zabaljauregui S AD - Academia Nacional de Medicina - Departamento de Hemato-Oncologia (Division Oncohematologia), Buenos Aires, Argentina. FAU - Shanley, Claudia AU - Shanley C AD - Hospital Britanico - Departamento de Hematologia (Unidad de Trasplante de Medula osea), Buenos Aires, Argentina. FAU - Lopresti, Sergio AU - Lopresti S AD - Hospital Posadas - Departamento de Medicina Interna, Moron, Argentina. FAU - Orlando, Sergio AU - Orlando S AD - Hospital Rodolfo Rossi - Departamento de Hematologia y Trasplante de Medula osea, La Plata, Argentina. FAU - Verri, Veronica AU - Verri V AD - Instituto de Investigaciones Medicas "Alfredo Lanari" UBA - Departamento de Hematologia, Buenos Aires, Argentina. FAU - Quiroga, Luis AU - Quiroga L AD - Complejo Medico de la Policia Federal Argentina Churruca Visca - Departamento de Clinica Medica (Seccion Hematologia), Buenos Aires, Argentina. FAU - Garcia, Carlos A AU - Garcia CA AD - Clinica 25 de Mayo, Mar del Plata, Argentina. FAU - Fernandez, Vanesa AU - Fernandez V AD - Sanatorio Dr. Julio Mendez - Departamento de Clinica Medica (Seccion Hematologia), Buenos Aires, Argentina. FAU - Fantl, Dorotea AU - Fantl D AD - Hospital Italiano de Buenos Aires - Servicio de Clinica Medica (Seccion Hematologia), Buenos Aires, Argentina. LA - eng GR - Takeda Pharmaceutical Company/ PT - Journal Article DEP - 20200420 PL - England TA - Hematol Oncol JT - Hematological oncology JID - 8307268 RN - 4Z8R6ORS6L (Thalidomide) RN - 69G8BD63PP (Bortezomib) RN - 7S5I7G3JQL (Dexamethasone) RN - 8N3DW7272P (Cyclophosphamide) SB - IM MH - Aged MH - Antineoplastic Combined Chemotherapy Protocols/*therapeutic use MH - Bortezomib/administration & dosage MH - Cyclophosphamide/administration & dosage MH - Dexamethasone/administration & dosage MH - Female MH - Follow-Up Studies MH - Humans MH - Induction Chemotherapy/*mortality MH - Male MH - Middle Aged MH - Multiple Myeloma/drug therapy/*mortality/pathology MH - Prognosis MH - Remission Induction MH - Retrospective Studies MH - Survival Rate MH - Thalidomide/administration & dosage OTO - NOTNLM OT - CyBorD OT - Latin America OT - VTD OT - induction therapy OT - multiple myeloma OT - real world EDAT- 2020/03/21 06:00 MHDA- 2020/09/01 06:00 CRDT- 2020/03/21 06:00 PHST- 2019/02/24 00:00 [received] PHST- 2020/01/27 00:00 [revised] PHST- 2020/03/08 00:00 [accepted] PHST- 2020/03/21 06:00 [pubmed] PHST- 2020/09/01 06:00 [medline] PHST- 2020/03/21 06:00 [entrez] AID - 10.1002/hon.2729 [doi] PST - ppublish SO - Hematol Oncol. 2020 Aug;38(3):363-371. doi: 10.1002/hon.2729. Epub 2020 Apr 20.