Bendamustine, Prednisone and Bortezomib (BPV) Induction Therapy Prior Autologous Stem Cell Transplantation (ASCT) in 135 Newly Diagnosed Multiple Myeloma Patients: Comparison Between Patients with Normal and Impaired Renal Function

Abstract

Introduction: Autologous stem cell transplantation (ASCT) is the standard first line treatment for younger patients with multiple myeloma (MM). Bortezomib and bendamustine have both been identified as rapidly acting and well-tolerated drugs for patients with MM-induced renal failure. In this retrospective study we analyzed the efficacy of induction therapy with a combination bendamustine, prednisone and bortezomib (BPV) prior to ASCT in newly diagnosed MM-patients (NDMM) depending on severity of renal impairment. Methods: 135 patients with NDMM were treated with BPV-induction. Results: The majority of patients (n=117; 87%) responded after BPV-induction with 9 sCR, 3 CR, 51 VGPR, and 54 PR. After first ASCT ORR increased to 99% with 33 sCR, 10 CR, 73 VGPR and 17 PR. Median PFS was 47 months and OS at 60 months was 67%. Patients were divided into four groups depending on severity of renal impairment: A (n=13) with eGFR<15mL/min, B (n=15) 15–29mL/min, C (n=19) 30-59mL/min and D (n=88) ≥60mL/min. We observed no significant difference in PFS between patients with normal/mild, moderate, severe renal dysfunction and renal failure/dialysis (50 vs 47 vs 34 vs 24 months, p=0.05) and in 60 months OS (69 vs 72 vs 58 vs 70%, p=0.23). The renal response rate improved from 68% after BPV to 74% following ASCT. Conclusion: These results indicate that BPV-induction followed by ASCT is feasible, effective and well tolerated in patients with MM-induced renal failure. Furthermore, we showed that pretreatment with short-term bendamustine had no negative impact on stem cell mobilization.