Real-World Comparison of Treatment Outcomes for Multiple Myeloma in Elderly Transplant Ineligible Patients Receiving First-Line VRd, Rd and VCd: Results From the Australian and New Zealand Myeloma and Related Diseases Registry
- Author(s)
- Zhao, S; Wellard, C; Moore, EM; Spencer, A; Quach, H; Ho, PJ; McDonald, EJ; Mollee, P; Harrison, SJ; Augustson, B; Wood, EM; McQuilten, ZK; Rajagopal, R;
- Journal Title
- Clinical Lymphoma, Myeloma & Leukemia
- Publication Type
- Online publication before print
- Abstract
- BACKGROUND: Real-world data on treatment outcomes for elderly transplant-ineligible patients with newly diagnosed multiple myeloma are limited. The difference in treatment subsidization in Australia compared with New Zealand enables comparison of bortezomib-cyclophosphamide-dexamethasone (VCd), lenalidomide-bortezomib-dexamethasone (VRd) with Rd maintenance, and continuous Rd. METHODS: Using data from the ANZ Myeloma and Related Diseases Registry, we evaluated 1092 patients over 70 years of age between February 2013 and February 2024. Those who received Rd, VRd or VCd induction, and did not undergo an autologous stem cell transplant were included. RESULTS: Overall response rates were 85.6%, 73.7%, and 91.5% for VCd, Rd, and VRd, respectively (P < 0.001). At a median follow-up of 37 months, VRd showed the longest median progression-free survival (PFS) of 27.5 months, compared to 23.7 months for Rd and 20.5 months for VCd (P = 0.01). After adjustment, PFS for VRd and Rd remained superior compared to VCd. Rd patients had the longest median time to next treatment (35.1 months), compared to 28.7 months for VRd and 20.1 months for VCd. Overall survival (OS) was superior with VRd (P = 0.039), with 3-year survival rates of 80% for VRd, 67% for Rd, and 67% for VCd. However, multivariate analysis did not show a significant difference in OS. CONCLUSION: Our study confirms VRd demonstrates superior PFS compared to Rd and VCd, but was underpowered to detect a significant difference in OS. More prospective real-world studies are needed to establish the optimal choice of induction therapy balancing efficacy and toxicity for this cohort in resource limited settings.
- Keywords
- Bortezomib; Lenalidomide; Registries; Survival; Toxicity
- Department(s)
- Haematology
- Publisher's Version
- https://doi.org/10.1016/j.clml.2025.08.004
- Open Access at Publisher's Site
https://doi.org/10.1016/j.clml.2025.08.004- Terms of Use/Rights Notice
- Refer to copyright notice on published article.
Creation Date: 2026-01-15 02:19:24
Last Modified: 2026-01-15 02:19:31