Frontline treatment of elderly non transplant-eligible multiple myeloma patients using CyBorD with or without thalidomide-based consolidation: a retrospective multi-centre analysis of real-world data

Bortezomib in combination with cyclophosphamide and dexamethasone (CyBorD, is a well-established frontline chemotherapy regimen for patients with multiple myeloma, but prospective data on elderly non-transplant eligible patients is limited. A total of 155 patients aged 70 years or older with newly diagnosed multiple myeloma who received at least one cycle of CyBorD chemotherapy in three centres across New Zealand were evaluated. Partial response or better was achieved in 79·4%, of whom 52·9% achieved at least a very good partial response. After a median follow-up of 31·9 months, the median event-free survival (EFS) was 17·0 months (age 70–80 years, 17·7 months; age above 80 years, 8·6 months; P = 0·002). The median overall survival was 45·1 months (age 70–80, 49·8 months; above 80, 33·3 months; P = 0·003). Amongst those who had seven or more cycles of treatment, those who had a pre-planned switch to bortezomib-thalidomide-dexamethasone (VTD) consolidation had a superior median EFS of 25·4 months, compared with 20·3 months in the CyBorD only group (P = 0·028). This is the largest real-world dataset on the efficacy of CyBorD in the elderly population, and pre-planned switch to VTD was associated with better outcomes.