Incorporating bortezomib into upfront treatment for multiple myeloma: Early results of total therapy 3

Bart Barlogie, Elias Anaissie, Frits Van Rhee, Jeffrey Haessler, Klaus Hollmig, Mauricio Pineda-Roman, Michele Cottler-Fox, Abid Mohiuddin, Yazan Alsayed, Guido Tricot, Vanessa Bolejack, Maurizio Zangari, Joshua Epstein, Nathan Petty, Douglas Steward, Bonnie Jenkins, Jennifer Gurley, Ellen Sullivan, John Crowley, John D. Shaughnessy

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278 Scopus citations


Total therapy 3 incorporated bortezomib into a melphalan-based tandem transplant regimen for 303 newly diagnosed patients with myeloma. Induction chemotherapy prior to and consolidation chemotherapy after transplants each consisted of two cycles of VTD-PACE (bortezomib, thalidomide, dexamethasone and 4-d continuous infusions of cis-platin, doxorubicin, cyclophosphamide, etoposide); 3-year maintenance comprised monthly cycles of VTD in the first and TD in the remaining years. The median age was 59 years (age >64 years, 28%). A minimum of 20 × 106 CD34 cells/kg was collected in 87% of patients; 83% completed both transplants, and only 5% suffered a treatment-related death. At 24 months, 83% had achieved near-complete remission, which was sustained in 88% at 2 years from its onset. With a median follow-up of 20 months, 2-year estimates of event-free and overall survival were 84% and 86% respectively. The 44 patients who experienced an event more often had a high-risk gene array profile, cytogenetic abnormalities and indicators of high lactate dehydrogenase, beta-2-microglobulin, creatinine and International Staging System stage. Toxicities of grade > 2 included thrombo-embolic events in 27% and peripheral neuropathy in 12%. Results of this phase-2 study demonstrated that bortezomib could be safely combined with multi-agent chemotherapy, effecting near-complete remission status and 2-year survival rates in more than 80% of patients.

Original languageEnglish
Pages (from-to)176-185
Number of pages10
JournalBritish Journal of Haematology
Issue number2
StatePublished - Jul 2007
Externally publishedYes


  • Autotransplant
  • Bortezomib
  • Myeloma


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