Bortezomib Induction and Maintenance Treatment in Patients With Newly Diagnosed Multiple Myeloma: Results of the Randomized Phase III HOVON-65/GMMG-HD4 Trial

Pieter Sonneveld*, Ingo G. H. Schmidt-Wolf, Bronno van der Holt, Laila el Jarari, Uta Bertsch, Hans Salwender, Sonja Zweegman, Edo Vellenga, Annemiek Broyl, Igor W. Blau, Katja C. Weisel, Shulamiet Wittebol, Gerard M. J. Bos, Marian Stevens-Kroef, Christof Scheid, Michael Pfreundschuh, Dirk Hose, Anna Jauch, Helgi van der Velde, Reinier RaymakersMartijn R. Schaafsma, Marie-Jose Kersten, Marinus van Marwijk-Kooy, Ulrich Duehrsen, Walter Lindemann, Pierre W. Wijermans, Henk M. Lokhorst, Hartmut M. Goldschmidt

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

544 Citations (Web of Science)

Abstract

Purpose We investigated whether bortezomib during induction and maintenance improves survival in newly diagnosed multiple myeloma (MM). Patients and Methods In all, 827 eligible patients with newly diagnosed symptomatic MM were randomly assigned to receive induction therapy with vincristine, doxorubicin, and dexamethasone (VAD) or bortezomib, doxorubicin, and dexamethasone (PAD) followed by high-dose melphalan and autologous stem-cell transplantation. Maintenance consisted of thalidomide 50 mg (VAD) once per day or bortezomib 1.3 mg/m(2) (PAD) once every 2 weeks for 2 years. The primary analysis was progression-free survival (PFS) adjusted for International Staging System (ISS) stage. Results Complete response (CR), including near CR, was superior after PAD induction (15% v 31%; P <.001) and bortezomib maintenance (34% v 49%; P <.001). After a median follow-up of 41 months, PFS was superior in the PAD arm (median of 28 months v 35 months; hazard ratio [ HR], 0.75; 95% CI, 0.62 to 0.90; P = .002). In multivariate analysis, overall survival (OS) was better in the PAD arm (HR, 0.77; 95% CI, 0.60 to 1.00; P = .049). In high-risk patients presenting with increased creatinine more than 2 mg/dL, bortezomib significantly improved PFS from a median of 13 months to 30 months (HR, 0.45; 95% CI, 0.26 to 0.78; P = .004) and OS from a median of 21 months to 54 months (HR, 0.33; 95% CI, 0.16 to 0.65; P <.001). A benefit was also observed in patients with deletion 17p13 (median PFS, 12 v 22 months; HR, 0.47; 95% CI, 0.26 to 0.86; P = .01; median OS, 24 months v not reached at 54 months; HR, 0.36; 95% CI, 0.18 to 0.74; P = .003). Conclusion Bortezomib during induction and maintenance improves CR and achieves superior PFS and OS.
Original languageEnglish
Pages (from-to)2946-2955
JournalJournal of Clinical Oncology
Volume30
Issue number24
DOIs
Publication statusPublished - 20 Aug 2012

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