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Myeloma

Cyclophosphamide, bortezomib and dexamethasone induction for newly diagnosed multiple myeloma: high response rates in a phase II clinical trial

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Abstract

We have studied a three-drug combination with cyclophosphamide, bortezomib and dexamethasone (CyBorD) on a 28-day cycle in the treatment of newly diagnosed multiple myeloma (MM) patients to assess response and toxicity. The primary endpoint of response was evaluated after four cycles. Thirty-three newly diagnosed, symptomatic patients with MM received bortezomib 1.3 mg/m2 intravenously on days 1, 4, 8 and 11, cyclophosphamide 300 mg/m2 orally on days 1, 8, 15 and 22 and dexamethasone 40 mg orally on days 1–4, 9–12 and 17–20 on a 28-day cycle for four cycles. Responses were rapid with a mean 80% decline in the sentinel monoclonal protein at the end of two cycles. The overall intent to treat response rate (⩾ partial response) was 88%, with 61% of very good partial response or better (⩾VGPR) and 39% of complete/near complete response (CR/nCR). For the 28 patients who completed all four cycles of therapy, the CR/nCR rate was 46% and VGPR rate was 71%. All patients undergoing stem cell harvest had a successful collection. Twenty-three patients underwent stem cell transplantation (SCT) and are evaluable through day 100 with CR/nCR documented in 70% and ⩾VGPR in 74%. In conclusion, CyBorD produces a rapid and profound response in patients with newly diagnosed MM with manageable toxicity.

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Acknowledgements

This investigator-initiated trial was supported by a grant from Millennium Pharmaceuticals.

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Authors and Affiliations

  1. Division of Hematology/Oncology, Mayo Clinic, Scottsdale, AZ, USA

    C B Reeder, J Hentz, B Noble, N A Pirooz, J E Spong, V H J Zepeda, J R Mikhael, J F Leis, P L Bergsagel, R Fonseca & A K Stewart

  2. Division of Hematology/Oncology, Princess Margaret Hospital, Toronto, Ontario, Canada

    D E Reece, V Kukreti, C Chen, S Trudel & J G Piza

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  1. C B Reeder
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  2. D E Reece
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  3. V Kukreti
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  4. C Chen
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  5. S Trudel
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  6. J Hentz
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  7. B Noble
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  8. N A Pirooz
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  9. J E Spong
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  10. J G Piza
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  11. V H J Zepeda
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  12. J R Mikhael
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  13. J F Leis
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  14. P L Bergsagel
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  15. R Fonseca
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Correspondence to C B Reeder.

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Reeder, C., Reece, D., Kukreti, V. et al. Cyclophosphamide, bortezomib and dexamethasone induction for newly diagnosed multiple myeloma: high response rates in a phase II clinical trial. Leukemia 23, 1337–1341 (2009). https://doi.org/10.1038/leu.2009.26

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  • DOI: https://doi.org/10.1038/leu.2009.26

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