Exploring Neuropathy and Patient-Reported Outcomes With Bortezomib and Lenalidomide in Newly Diagnosed MM

Patients with newly diagnosed multiple myeloma (MM) treated with combination regimen of bortezomib, lenalidomide, and dexamethasone (VRd) induction followed by early autologous stem cell transplantation (ASCT) did not have a greater occurrence of clinically significant neuropathy in the first 12 months after diagnosis compared to patients who did not receive early ASCT. Moreover, VRd induction was associated with a considerable improvement in overall health related quality of life (HRQoL) at 12 months regardless of whether patients received early ASCT, according to findings from a longitudinal analysis (Clin Lymphoma Myeloma Leuk. 2022; S2152-2650(22)00219-1. doi:10.1016/j.clml.2022.07.002).

In this study, Ajay Major, MD, Section of Hematology/Oncology, Department of Medicine, The University of Chicago, Chicago, Illinois and colleagues conducted a longitudinal database analysis in which they aimed to characterize the contributions of both bortezomib and lenalidomide to short- and long-term longitudinal development of neuropathy in patients treated with frontline VRd, by utilizing the frontline regimen bortezomib, cyclophosphamide, and dexamethasone (VCd, also known as CyBorD) as a comparator and accounting for the utilization of early consolidative ASCT.

In addition, researchers aimed to describe longitudinal changes in PROs to evaluate how neuropathy may affect HRQoL during the frontline treatment of MM.

For this study, the Multiple Myeloma Research Foundation (MMRF) CoMMpass Registry was examined for all patients who received frontline VRd or VCd as frontline therapy for newly diagnosed MM.

Incidence of neuropathy and patient-reported HRQoL outcomes over the first 12 months after diagnosis were compared between patients receiving VRd or VCd with or without early ASCT before 6 months.

Results revealed there were 368 and 191 patients treated with VRd and VCd, respectively. VRd with early ASCT was correlated with worse grade 1 neuropathy compared to VRd without early ASCT, as well as compared to VCd with early ASCT. There were no differences in neuropathy between VRd and VCd without early ASCT, and no differences in grade ≥2 neuropathy. There were noteworthy enhancements in HRQoL between baseline and 12 months in both VRd and VCd cohorts, regardless of early ASCT. Development of neuropathy was not correlated with declines in progression-free survival or overall survival.

Dr Major and colleagues concluded, “There were no differences in grade ≥2 neuropathy between VRd and VCd frontline induction, and overall HRQoL significantly improved across all cohorts,” adding, “However, differences in grade 1 neuropathy between VRd and VCd induction suggest that lenalidomide and high-dose melphalan may augment the risk of neuropathy in newly diagnosed multiple myeloma.”