Sequential, Alternating Regimens Demonstrate Similar Efficacy in Multiple Myeloma

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VMP and Rd demonstrate efficacy in older patients with newly diagnosed multiple myeloma.
VMP and Rd demonstrate efficacy in older patients with newly diagnosed multiple myeloma.

Bortezomib plus melphalan and prednisone (VMP) and lenalidomide plus low-dose dexamethasone (Rd) demonstrate efficacy in older patients with newly diagnosed multiple myeloma, regardless of a sequential or alternating regimen, according to a Spanish study published in Blood.1

Researchers led by María-Victoria Mateos, MD, PhD, of Complejo Asistencial Universitario de Salamanca, Instituto de Investigacion Biomedica de Salamanca in Spain looked at 233 patients with untreated multiple myeloma who were older than 65 years.

Patients were randomized to receive 9 cycles of VMP followed by 9 cycles of Rd in a sequential scheme or one cycle of VMP followed by one cycle of Rd with up to 18 cycles as part of an alternating scheme. Primary endpoint was 18-month progression-free survival (PFS) and safety profile for both schemes.

RELATED: Impact of Reproductive Factors, Exogenous Hormones in Multiple Myeloma Risk Evaluated

The researchers found that 18-month PFS was 74% in the sequential scheme and 80% in the alternating scheme.

Both schemes demonstrated similar hematological and non-hematological toxicity, and yielded similar complete response rate, median PFS, and 3-year overall survival. Benefit of both schemes was found to be “particularly remarkable” in patients 65 to 75 years.

Additionally, achieving complete and immunophenotypic responses were associated with better outcomes in patients.


  1. Mateos M, Martínez-Lopez J, Hernández M, et al. Sequential versus alternating administration of VMP and Rd in elderly patients with newly diagnosed MM [published online ahead of print October 23, 2015]. Blood. doi:

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