Post-ASH 2018: The Impact of the Lenalidomide, Bortezomib and Dexamethasone on QoL of Recently Diagnosed Patients with Multiple Myeloma Eligible for ASCT

Oral presentation by Dr. Murielle Roussel

Multiple myeloma (MM) is a pathology with a very high symptom burden at the beginning of care. The bortezomib, lenalidomide, and dexamethasone (VRd) regimen is one of the most effective treatment options in terms of progression-free survival (PFS) in patients treated in the first line, regardless of whether this regimen includes an autologous transplant or not (IFM/DFCI 2009 study, published in the New England Journal of Medicine in 2017). Nevertheless, an overall survival benefit has not been demonstrated.

The authors presented the quality of life (QoL) results of this study in newly-diagnosed patients with MM. This randomized, phase III study compared three cycles of VRd in induction followed by five cycles of VRd in consolidation (VRd alone arm) versus three cycles of VRd in induction followed by autologous transplant then VRd in consolidation (VRd-autologous transplant arm). Both arms received maintenance treatment with lenalidomide for 12 months.

QoL was evaluated using two questionnaires that focused on different areas of QoL. These questionnaires were administered at nine different points during the study. The completion rate of the questionnaires ranged from 90% at the beginning of the study to 75%, but decreased to 42% just after the autologous transplant. Overall, the results demonstrated a significant linear improvement in QoL in both groups during treatment compared to when care was initiated. After six months, the QoL of the patients in the study was on par with the QoL of the general population. All QoL parameters improved rapidly and to a significant degree, except for fatigue, which only improved after 6 months (fatigue gets significantly worse during the transplant period before improving). The authors also noted a temporary deterioration in QoL just after transplantation into the VRd-autologous transplant arm, but then the level of QoL quickly reached that of the group with VRd alone.

This study demonstrates that newly-diagnosed patients with MM can have a QoL that is similar to that of the general population thanks to VRd triplet therapy, despite the potential side effects of the treatment. These new QoL data reinforce the role of VRd as first-line treatment given that not just PFS, but also QoL improves. The VRd regimen is not yet approved in Canada. These QoL data should provide additional arguments in favour of having the health authorities recognize this regimen as a standard first-line treatment in MM patients who may or may not be candidates for transplantation.

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