Bortezomib-based induction treatment
The current preferred induction therapy for transplant eligible patients is a proteasome inhibitor/corticosteroid-based regime. Ideally a third or fourth drug is added to improve treatment response.
More recent clinical trial results showed that adding daratumumab to VTD induction treatment improved depth of response and progression-free survival with acceptable safety. This combination is therefore now available in England, Scotland and Wales for patients eligible for HDT-SCT and is widely viewed as the preferred option at this stage. Daratumumab monotherapy is discussed further later in this chapter.
The most commonly used combinations available in the UK at first line for transplant-eligible patients are:
- Daratumumab, bortezomib, thalidomide and dexamethasone (DVTd)
- Bortezomib, dexamethasone and thalidomide (VTD)
- Bortezomib, dexamethasone and cyclophosphamide (VCD)
Side effects
| Treatment | Potential side effects |
|---|---|
| Bortezomib | Nausea and vomiting, diarrhoea, constipation, fatigue, weight loss, infections, peripheral neuropathy, change in taste, skin rash, muscle cramps and spasms |
| Thalidomide | Somnolence, peripheral neuropathy, venous-thromboembolism (VTE), anaemia, fatigue, constipation, skin rashes |
| Cyclophosphamide | Nausea and vomiting, diarrhoea, hair loss, weight loss, sore mouth, infections, fatigue, anaemia, skin rash, infertility |
| Dexamethasone | Stomach irritation, increased appetite, fluid retention, swelling in feet and hands, changes in blood sugar levels, infections, mood swings, insomnia, muscular problems, eye complications |
| Daratumumab | Peripheral neuropathy, fluid retention, low blood counts, fatigue, gastrointestinal disturbances, muscle spasms, headache, fever, cytokine release syndrome |