Bortezomib in combination with thalidomide and dexamethasone in patients with newly diagnosed multiple myeloma: evaluation of efficacy and safety in real clinical practice

Abstract

Multiple myeloma (MM) is a common hematological malignancy. The high efficacy of the VTD induction regimen (bortezomib, thalidomide, dexamethasone) is limited by dose-dependent adverse reactions of thalidomide.  Objective. To evaluate the effect of a thalidomide dose-escalation strategy in the VTD regimen on efficacy and safety in patients with newly diagnosed MM. Materials and methods. In a single-center prospective study (n=93; 2018–2025), patients received VTD with thalidomide dose escalation from 50 mg/day to 100 mg/day. Response was assessed according to IMWG criteria. Results. The overall response rate was 78.5% (95.7% in evaluable patients). The main dose-limiting reactions were constipation (32.3%) and rash (23.7%), with a low incidence of neuropathy (9.7%). The target dose was received by 58.1% of patients. A direct correlation was found between thalidomide dose intensity and depth of response (p<0.001). Median progression-free survival was not reached. Conclusion. The dose-escalation strategy of thalidomide in the VTD regimen demonstrates high efficacy and acceptable tolerability. Maintaining a high dose through toxicity management is associated with a better response. Keywords: hemoblastosis, multiple myeloma, thalidomide, bortezomib, adverse reactions.