Comparative Study Reveals Pomalidomide Outperforms Lenalidomide In Myeloma Treatment

In a recent study, researchers compared two induction regimens for treating high-risk newly diagnosed multiple myeloma patients: Bortezomib-Pomalidomide-Dexamethasone (VPd) and Bortezomib-Lenalidomide-Dexamethasone (VRd). The findings, derived from a retrospective analysis of patients treated between January 2021 and November 2023, showcased notable differences in efficacy and safety between the two therapies. The study involved 25 patients treated with VRd and 21 patients treated with VPd, with the primary aim of assessing the overall response rate (ORR) after four treatment cycles.

After completing the induction therapy, the results revealed that the VRd group had an ORR of 92%, whereas the VPd group achieved a remarkable 100% ORR. Notably, a very good partial response (VGPR) or better was seen in 52% of patients receiving VRd, while a striking 90.47% of those treated with VPd reached the same threshold. Statistically, this difference was significant, with a p-value of 0.003. These promising findings suggest that VPd may elicit a deeper and more effective response in patients battling this aggressive form of blood cancer.

Multiple myeloma (MM) impacts plasma cells and is recognized as the second most common blood malignancy. While advancements in treatment have improved the prognosis for many patients, high-risk newly diagnosed multiple myeloma (HRNDMM) continues to challenge healthcare providers due to poorer survival rates. Standard initial treatment typically includes cytotoxic chemotherapy, followed by possible autologous stem cell transplantation (ASCT) and ongoing maintenance therapy. However, the quest for more effective treatment options remains ongoing, particularly for patients classified as high risk.

The retrospective study conducted at Anqing City Hospital, approved by the Ethics Association, sought to evaluate the comparative effectiveness of two triplet induction regimens. Both VRd and VPd regimens were administered either on a 21-day or 28-day cycle, consisting of bortezomib combined with either lenalidomide or pomalidomide, along with dexamethasone. The study’s research design included rigorous monitoring of overall survival (OS), progression-free survival (PFS), and adverse events (AEs).

After four cycles, the average overall survival was recorded at 27 months for the VRd cohort compared to 21 months for those receiving VPd, although the findings were not statistically significant (p = 0.801). Likewise, the PFS was similar across groups with durations of 27 months for VRd and 20 months for VPd (p = 0.116). Despite these comparable survival rates, the pronounced difference in response rates highlights the potential advantages of VPd as an induction therapy.

Examining adverse events, the most common hematologic issues were consistent in both treatment arms, with bone marrow suppression being noted in most patients. Peripheral sensory neuropathy occurred at a similar rate across both groups, while the incidence of skin rash was higher among patients receiving VPd, with a p-value of 0.024, underscoring the need for continued surveillance in terms of safety.

This evaluation's strengths lie in its detailed assessments and comprehensive patient monitoring, with the majority of patients undergoing evaluations for eligibility and treatment response criteria set forth by the International Myeloma Working Group (IMWG). However, potential limitations include the study's retrospective nature and the relatively small sample size, which may affect generalizability.

Findings suggest that VPd induction therapy may confer superior response rates when compared with VRd for managing high-risk newly diagnosed multiple myeloma patients. The implication of this study highlights pomalidomide's potential role in first-line therapy, enhancing treatment outcomes for patients experiencing more aggressive forms of the disease.

In conclusion, the research offers critical insights into the management of HRNDMM, indicating that while both induction regimens are effective, VPd appears to facilitate deeper and more favorable treatment responses. Continuous exploration of novel therapeutic avenues remains essential to improving survival and quality of life for those affected by this challenging malignancy.