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

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, 12 nCR, 39 VGPR, and 54 PR. After first ASCT ORR increased to 99% with 33 sCR, 10 CR, 32 nCR, 41 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 61% after BPV to 74% following ASCT. Conclusions 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.