Abstract

Context: Triplet regimens with proteasome inhibitors, immunomodulatory drugs and steroid are common induction regimens used in Multiple Myeloma patients. Aims: We did a retrospective analysis of newly diagnosed multiple myeloma patients (NDMM) treated with VCd (Bortezomib, Cyclophosphamide, Dexamethasone) induction therapy in a resource constraint setting. Settings and Design: Electronic medical records of 26 NDMM patients attending a tertiary medical center in South India were analyzed. Methods and Material: The response rates of 26 NDMM patients treated with once weekly VCd induction and the clinically significant toxicities with this regimen were studied. Both transplant eligible and ineligible patients were included. Treatment responses after the 2nd and the 6th cycles of VCd were analyzed according to the IMWG uniform response criteria. The severity of toxicities were categorized using NCI-CTAE version 5 grading system. Statistical analysis used: IBM SPSS version 28 software was used for analyzing the results. Results: Of the 26 patients enrolled, 50% were above the age of 65 years. Median follow up was 17.5 months. In an intention to treat (ITT) analysis, the ORR was 57.7% (15/26) with VCd after 6 cycles, with CR of 34.6% (9/26), VGPR 19.2% (5/26) and PR 5.3% (1/19). The major toxicity was ≥ grade 2 peripheral neuropathy (PN). Grade 2 or more cytopenias were seen in 3 patients. 3 patients had grade 2 & 3 infections. 8% patients discontinued the treatment due to adverse events and 32% required bortezomib dose reduction. Conclusions: VCd is an effective induction regimen for NDMM patients with early deep response rates. This is especially important in LMICs like India, where the out of pocket healthcare expenditure is around 60%. VCd is a feasible regimen even for elderly NDMM patients with comorbidities

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