Modified HyperCVAD Versus Bortezomib-HyperCAD in Patients With Relapsed/Refractory Multiple Myeloma

Despite the availability of novel treatments for multiple myeloma, resistance to chemotherapy inevitably develops. We retrospectively reviewed the outcomes of patients with relapsed and/or refractory disease treated with modified hyperCVAD (n = 15) or bortezomib-hyperCAD (n = 18). Effectiveness and safety outcomes were similar in each group, with the entire cohort of patients showing an overall response rate of 42%. Introduction Multiple myeloma (MM) is an incurable plasma cell malignancy, in which aggressive relapses might require salvage cytotoxic infusional chemotherapy. Several clinical trials that reported the efficacy of bortezomib led to institutional practice changes in which vincristine was replaced with bortezomib in the modified hyperCVAD regimen, creating a new treatment regimen, named “bortezomib-hyperCAD.” Patients and Methods We retrospectively describe the effectiveness and tolerability of 2 chemotherapy regimens among 33 patients with relapsed and/or refractory MM. Patients who received ≥ 1 cycle of modified hyperCVAD or bortezomib-hyperCAD between 2011 and 2015 were assessed. Results The median number of cycles administered in each arm was 2. The overall response rate was 40% (6 partial responses) in the modified hyperCVAD group and 44.4% (1 complete response, 1 very good partial response, and 6 partial responses) in the bortezomib-hyperCAD group (Fisher exact P =.80). Median progression-free survival (PFS) and median overall survival (OS) for patients in the modified hyperCVAD group was 6.3 months and 11.1 months, respectively. This was comparable with patients in the bortezomib-hyperCAD group, who had a median PFS of 6.6 months and a median OS of 13.8 months (log rank P =.54 and.66, respectively). There was no statistically significant association between treatment arm and febrile neutropenia, emergency department visits, hospitalizations, or peripheral neuropathy (all Fisher exact P values >.05). Conclusion Overall effectiveness and tolerability outcomes were similar between modified hyperCVAD and bortezomib-hyperCAD, with both regimens showing an impressive response rate among refractory and heavily pretreated patients with relapsed MM.