Researchers from France recently published the preliminary results of a clinical trial evaluating chemotherapy induction and consolidation treatment with Revlimid (lenalidomide), Velcade (bortezomib), and dexamethasone (RVD) followed by Revlimid maintenance in 31 symptomatic previously untreated transplantation-eligible patients with multiple myeloma under the age of 65. Patients were treated with three cycles of RVD induction followed by autologous stem cell transplantation. Patients then received two RVD consolidation cycles and 1 year of Revlimid maintenance therapy.

Multiple myeloma is a cancer of plasma cells, which are a special type of white blood cell that are part of the body’s immune system. Patients with multiple myeloma have increased numbers of abnormal plasma cells that may produce increased quantities of dysfunctional antibodies detectable in the blood and/or urine. High dose chemotherapy and autologous stem cell transplant (ASCT) is standard treatment for individuals diagnosed with multiple myeloma. Doctors continue to evaluate ways to improve the outcomes of ASCT with the goal of improving survival and making the treatment more tolerable.

In this clinical trial at least a very good partial response was achieved in 58% of patients by the completion of 3 cycles of RVD induction therapy.  This improved to 70% following ASCT, and 87% after Revlimid consolidation therapy. Maintenance Revlimid resulted in and upgrade of the best response in 27% of patients.  After a median follow-up of 39 months, the estimated number of patients alive without evidence of cancer progression at 3 years was 77% and 3-year overall survival was 100%.  The treatment was well tolerated and the most common side effects with RVD were sensory neuropathies, and low white blood counts.

The RVD and ASCT treatment program appears well tolerated and has the potential to improve outcomes in the management of newly diagnosed stage 2 and 3 multiple myeloma patients preparing to undergo ASCT.  Evaluation of this program is ongoing at the Dana-Farber Cancer Institute.

Reference: Roussel M, Lauwers-Cances V, Robillard N, et al. Front-Line Transplantation Program With Lenalidomide, Bortezomib, and Dexamethasone Combination As Induction and Consolidation Followed by Lenalidomide Maintenance in Patients With Multiple Myeloma: A Phase II Study by the Intergroupe Francophone du Myélome. Journal of Clinical Oncology. Published online before print July 14, 2014, doi: 10.1200/JCO.2013.54.8164

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