In patients with multiple myeloma with light chain–induced renal failure, treatment with a combination known as BDD (bortezomib [Velcade], doxorubicin [Adriamycin], and dexamethasone [Decadron]) resulted in a high rate of myeloma and renal responses that was well tolerated by patients (J Clin Oncol. 2010;28:4635-4641).
In this study, 68 patients (median age, 65.6 years) with light chain– induced renal failure (as defined by a decrease in glomerular filtration rate to <50 mL/min) were given BDD. If well tolerated after 2 cycles, the bortezomib dose was increased and doxorubicin was given on additional days.
Myeloma responses were categorized as complete response (CR), nearcomplete response (nCR), very good partial response (VGPR), partial response (PR), and minor response (MR); renal responses were categorized as complete, partial, or minor. The median number of treatment cycles in the intent-to-treat and evaluable population was 8; 26 patients (38%) achieved CR/nCR, 10 (15%) achieved VGPR, 9 (13%) achieved PR, and 4 (6%) achieved MR.
Overall survival was 72% at 1 year and 58% at 2 years in the intent-to-treat population. Anemia was the most common hematologic toxicity, with 50% of patients presenting with either grade 3 or 4 toxicity; infection was the most common nonhematologic toxicity (19.1%).
