A combination regimen of bortezomib, cyclophosphamide and betamethasone gives quicker, better and more durable response than VAD/CyBet regimens: results from a Swedish retrospective analysis

Acta Haematol. 2013;130(1):7-15. doi: 10.1159/000345422. Epub 2013 Jan 25.


Background: Induction therapy for multiple myeloma (MM) and remission status before high-dose treatment (HDT) have been shown to be prognostic factors for survival outcome, although the optimal induction therapy is yet to be defined.

Methods: We conducted a retrospective analysis of the impact of induction therapy on survival outcome before and after HDT in MM patients. The study included 236 consecutive patients who underwent HDT.

Results: One hundred and forty-two patients (62%) were treated with vincristine, doxorubicin and dexamethasone (VAD) or cyclophosphamide and betamethasone (CyBet) and 94 (38%) were treated with bortezomib, cyclophosphamide and betamethasone (VCB) as induction. Time to first and time to best response was faster in the VCB group than in the VAD/CyBet group, with 42 versus 75 (p < 0.001) and 54 versus 88 days (p < 0.001), respectively. After induction therapy, 49% of the patients in the VCB group and 38% in the VAD/CyBet group achieved a very good partial response or better. Multivariate analysis revealed younger age, lower International Staging System stage and induction treatment with VCB as variables associated with favourable time to progression.

Conclusions: Outcome measured as response and time to progression before and after HDT in MM differs depending on type of induction treatment and suggests that VCB is a highly effective induction regimen that confers a post-HDT advantage.

MeSH terms

  • Adult
  • Aged
  • Antineoplastic Agents / administration & dosage
  • Antineoplastic Agents, Alkylating / administration & dosage
  • Antineoplastic Combined Chemotherapy Protocols / administration & dosage*
  • Betamethasone / administration & dosage*
  • Boronic Acids / administration & dosage*
  • Bortezomib
  • Cyclophosphamide / administration & dosage*
  • Dexamethasone / administration & dosage
  • Doxorubicin / administration & dosage
  • Drug Therapy, Combination
  • Female
  • Glucocorticoids / administration & dosage
  • Humans
  • Male
  • Middle Aged
  • Multiple Myeloma / drug therapy*
  • Multiple Myeloma / mortality
  • Multivariate Analysis
  • Proportional Hazards Models
  • Pyrazines / administration & dosage*
  • Retrospective Studies
  • Sweden
  • Treatment Outcome
  • Vincristine / administration & dosage


  • Antineoplastic Agents
  • Antineoplastic Agents, Alkylating
  • Boronic Acids
  • Glucocorticoids
  • Pyrazines
  • Vincristine
  • Bortezomib
  • Dexamethasone
  • Doxorubicin
  • Cyclophosphamide
  • Betamethasone

Supplementary concepts

  • VAD protocol