Abstract
In high-risk newly diagnosed multiple myeloma (HRNDMM), two different induction regimens were evaluated for safety and efficacy: Bortezomib-Pomalidomide-Dexamethasone (VPd) and Bortezomib-Lenalidomide-Dexamethasone (VRd). Newly diagnosed high-risk MM patients(age > 18) were included in this retrospective study, who received VRd and VPd induction therapy between January 2021 and November 2023. All methods of this experiment were performed in accordance with relevant guidelines and regulations. Informed consent has been obtained from all subjects and/or their legal guardians. The Ethics Association of Anqing City Hospital has approved the study on pomadomide in this experiment (Medical Review (2021) No. 27). The evaluation of OS (overall survival), PFS (progression free survival), AE (adverse event) was the secondary endpoints, while the primary endpoint of the study was the overall response rate (ORR) after four cycles of VRd and VPd. Ultimately, 25 patients with VRd and 21 patients with VPd were enrolled. After four cycles of induction, stringent complete, complete, very good partial, partial and overall response rates were 16%/24%/12%/40%/92% with VRd, and 23.81%/33.33%/33.33%/9.52%/100% with VPd. VGPR or better was achieved in 52% of patients receiving VRd compared to 90.47% in those receiving VPd, with a p-value of 0.003. VPd was linked to more cases of skin rash (p = 0.02). For VRd and VPd, the average overall survival time was 27-months and 21-months, respectively (p = 0.801). The PFS was 27-months for VRd and 20-months for VPd (p = 0.116). Median OS and PFS were not defined in both groups. According to our research, the induction of VPd has been found to elicit more profound and superior responses in HRNDMM compared to VRd, thereby establishing its safety. Our results underscore the potential clinical advantage of pomalidomide as first-line therapy and offer more proof of the beneficial efficacy of VPd in the treating of HRNDMM patients.