Head-to-head: VMP versus Rd in transplant-ineligible MM

A head-to-head comparison between bortezomib-melphalan-prednisone (VMP) and lenalidomide-dexamethasone (Rd) did not show a progression-free survival (PFS) difference between both treatment regimens in transplant-ineligible patients with multiple myeloma (MM). However, a trend was observed that VMP seems to be the better option in high-risk patients.

“VMP and Rd are both standard therapies for patients with untreated MM who cannot receive transplant,” explained Dr Sara Bringhen (Università degli Studi di Torino, Italy). “It has not yet been established whether one of the treatment regimens leads to better health outcomes than the other.” To investigate this matter, the phase 4 REAL-MM trial (NCT03829371) randomised 231 patients with newly diagnosed MM who were ineligible for transplant 1:1 to VMP or Rd [1]. The primary outcome was PFS.

After a median follow-up of 18.9 months, there was no difference in PFS between participants in the VMP arm and those in the Rd arm (HR 0.82; 95% CI 0.51–1.31; P=0.41), with 2-year PFS rates of 56% and 55%. Although the association was not significant, the data showed that in participants with high cytogenetic risk (n=35), VMP may be preferred over Rd (HR 0.22; 95% CI 0.05–1.07; P=0.06). Dr Bringhen added that there was no PFS difference according to frailty status. Finally, the 2-year overall survival (OS) rates appeared to favour participants who were treated with VMP (89% vs 75%; HR 0.53; 95% CI 0.26–1.07; P=0.076). However, longer follow-up is needed to evaluate whether this trend will lead to a significant OS benefit.

1. Bringhen S, et al. Bortezomib-Melphalan-Prednisone (VMP) Vs. Lenalidomide-Dexamethasone (Rd) in Transplant-Ineligible Real-Life Multiple Myeloma Patients: Updated Results of the Randomized Phase IV Real MM Trial. Abstract 751, ASH 64^th Annual Meeting, 10–13 December 2022, New Orleans, LA, USA.

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