Annals of Hematology

, Volume 91, Issue 2, pp 249–256 | Cite as

Sequential vincristine, adriamycin, dexamethasone (VAD) followed by bortezomib, thalidomide, dexamethasone (VTD) as induction, followed by high-dose therapy with autologous stem cell transplant and consolidation therapy with bortezomib for newly diagnosed multiple myeloma: results of a phase II trial

  • Hye Jin Kim
  • Sung-Soo Yoon
  • Dong Soon Lee
  • Sang Kyun Sohn
  • Hyeon Seok Eom
  • Jung Lim Lee
  • Joo Seup Chung
  • Kihyun Kim
  • Cheolwon Suh
  • Jong Ho Won
  • Jin Seok Kim
  • Joon Seong Park
  • Hye Jin Kang
  • Chu Myong Seong
  • Cheol Soo Kim
  • Sang Jae Lee
  • Jae Hoon Lee
Original Article

Abstract

Incorporation of novel agents has resulted in an improved response rate and reduced side effects in multiple myeloma. This has prompted combining novel agents in induction chemotherapy in patients with newly diagnosed multiple myeloma. Our patients received 2 cycles of vincristine, adriamycin, dexamethasone (VAD) and then 2 cycles of bortezomib, thalidomide, dexamethasone (VTD) chemotherapy as an induction treatment. Subsequently, autologous stem cell transplantation was performed, and bortezomib was administered as a consolidation therapy. Seventy-one patients were enrolled, and 65 were evaluable for response. After 2 cycles of VAD, the overall response rate was 69%. After VTD, the response rate improved to 97% with a complete response (CR) and near CR rate of 27%. Importantly, patients with cytogenetics, having poor prognostic features, all responded after VTD. Autologous stem cells were successfully collected in all 58 patients with a median CD34+ cell count of 7.12 × 106/kg (range, 1.94–44.7 × 106/kg), except in 1 patient (2%). After ASCT, 36 patients completed bortezomib maintenance with a combined CR and near CR rate approaching 75%. Median time to response was rapid (1.6 months). With a median follow-up duration of 52.7 months, the median TTP was 29.4 months and median OS was not reached. Toxicities proved manageable. In conclusion, sequential VAD and VTD induction therapy in patients with newly diagnosed multiple myeloma was active with manageable toxicity and excellent stem cell yields. The incorporation of bortezomib as a consolidation therapy improved the clinical outcome with the expense of rather frequent development of peripheral neuropathy.

Keywords

Bortezomib Thalidomide Multiple myeloma 

Notes

Acknowledgments

The authors would like to thank Sun Jong Lee for her efforts in data collection, Yun Jeong Kim for her administrative assistance, and KMMWP. This work was supported by a grant of (1) the Korea Health 21 R&D Project, Ministry for Health, Welfare and Family Affairs, R.O.K. (A084783) and (2) the Korea Health 21 R&D project, Ministry for Health, Welfare and Family Affairs, R.O.K. (A030001) and in part, by Janssen Korea.

Financial disclosure statement

The authors have nothing to disclose.

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Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Hye Jin Kim
    • 1
  • Sung-Soo Yoon
    • 2
    • 17
  • Dong Soon Lee
    • 2
  • Sang Kyun Sohn
    • 3
  • Hyeon Seok Eom
    • 4
  • Jung Lim Lee
    • 5
  • Joo Seup Chung
    • 6
  • Kihyun Kim
    • 7
  • Cheolwon Suh
    • 8
  • Jong Ho Won
    • 9
  • Jin Seok Kim
    • 10
  • Joon Seong Park
    • 11
  • Hye Jin Kang
    • 12
  • Chu Myong Seong
    • 13
  • Cheol Soo Kim
    • 14
  • Sang Jae Lee
    • 15
  • Jae Hoon Lee
    • 16
  1. 1.The Armed Forces Capital HospitalSeoulSouth Korea
  2. 2.Clinical Research InstituteSeoul National University College of MedicineSeoulSouth Korea
  3. 3.Kyungbook National University HospitalDaeguSouth Korea
  4. 4.National Cancer CenterGoyang, KyunggiSouth Korea
  5. 5.Daegu Fatima HospitalDaeguSouth Korea
  6. 6.Pusan University HospitalPusanSouth Korea
  7. 7.SungKyungKwan University, Samsung Medical CenterSeoulSouth Korea
  8. 8.Asan Medical CenterSeoulSouth Korea
  9. 9.Soon Chun Hyang University HospitalSeoulSouth Korea
  10. 10.Yonsei University Severance HospitalSeoulSouth Korea
  11. 11.Ajou University HospitalSuwon, KyunggiSouth Korea
  12. 12.Korea Institute of Radiological and Medical ScienceSeoulSouth Korea
  13. 13.Ewha Women’s University HospitalSeoulSouth Korea
  14. 14.Inha University HospitalIncheonSouth Korea
  15. 15.Chung-Ang University HospitalSeoulSouth Korea
  16. 16.Gachon University Gil HospitalIncheonSouth Korea
  17. 17.Division of Hematology, Department of Internal MedicineSeoul National University College of MedicineSeoulSouth Korea

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