Discussion
multiple myeloma, pre-renal, chronic kidney disease, MM, febrile neutropenia, toxicity, anemia, diabetic, septic shock, deaths, community-acquired acute gastroenteritis, non-neutropenic, acute kidney injury
MULTIPLE MYELOMA, FEBRILE NEUTROPENIA, ANEMIA, SECONDARY, LOWER LIMB CELLULITIS, SEPTIC SHOCK, MYELOMA, MINIMAL RESIDUAL DISEASE (MRD)
One of the main goals of induction chemotherapy in newly diagnosed MM is achieving the deepest possible response, which may influence long-term outcomes [In our study, 48% of patients achieved complete metabolic response (CMR) on PET/CT. 18F-FDG-PET/CT is comparable to multiparameter flow cytometry to define minimal residual disease (MRD) in MM [The VPd regimen showed a manageable toxicity profile in our study. Two early deaths happened in the first cycle, of which one could be directly attributed to the drug. The first patient, a long-standing diabetic, died of febrile neutropenia and septic shock secondary to bilateral lower limb cellulitis. The second patient presented with a pre-renal form of acute kidney injury following an episode of community-acquired acute gastroenteritis and was non-neutropenic at presentation. Only one patient required dose modification for pomalidomide because of chronic kidney disease. None of the patients discontinued therapy. VPd was safe and effective in patients with advanced age and comorbidities. The OPTIMISSM study, which used a VPd combination for RRMM, showed anemia of any grade in 27% of patients and grade 3/4 in 13% of patients, respectively [The median duration from diagnosis of multiple myeloma to ASCT is eight months. This duration is earlier than other studies from the country where the median duration was 10–10.5 months [The PFS and OS at one year in our study were 67.7% and 70.7%, respectively. These rates are significantly lesser than the reported survival rates of myeloma in the modern era [A few limitations of our study were that FISH for cytogenetic abnormalities could not be carried out in all the patients. Due to logistical difficulties, the assessment of MRD using multiparameter flow cytometry couldn’t be performed.We conclude that induction chemotherapy using bortezomib, pomalidomide, and dexamethasone is safe and efficacious in newly diagnosed multiple myeloma. This regimen achieved higher rates of very good partial response and better than the conventionally used bortezomib-lenalidomide-dexamethasone regimen. Further Phase 3 studies with longer follow-ups are necessary to establish the superiority and survival benefit of the pomalidomide-based regimen for myeloma induction.