Cyclophosphamide Bortezomib Dexamethasone

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Standard Regimen

Bortezomib 1.3 mg/m(2) intravenously on days 1, 4, 8 and 11
Cyclophosphamide 300 mg/m(2) orally on days 1, 8, 15 and 22
Dexamethasone 40 mg orally on days 1-4, 9-12 and 17-20 on a 28-day cycle

Reference

Reeder CB et al Cyclophosphamide, bortezomib and dexamethasone induction for newly diagnosed multiple myeloma: high response rates in a phase II clinical trial. Leukemia. 2009 Jul;23(7):1337-41. Epub 2009 Feb 19.
We have studied a three-drug combination with cyclophosphamide, bortezomib and dexamethasone (CyBorD) on a 28-day cycle in the treatment of newly diagnosed multiple myeloma (MM) patients to assess response and toxicity. The primary endpoint of response was evaluated after four cycles. Thirty-three newly diagnosed, symptomatic patients with MM received bortezomib 1.3 mg/m(2) intravenously on days 1, 4, 8 and 11, cyclophosphamide 300 mg/m(2) orally on days 1, 8, 15 and 22 and dexamethasone 40 mg orally on days 1-4, 9-12 and 17-20 on a 28-day cycle for four cycles. Responses were rapid with a mean 80% decline in the sentinel monoclonal protein at the end of two cycles. The overall intent to treat response rate (>or= partial response) was 88%, with 61% of very good partial response or better (>or=VGPR) and 39% of complete/near complete response (CR/nCR). For the 28 patients who completed all four cycles of therapy, the CR/nCR rate was 46% and VGPR rate was 71%. All patients undergoing stem cell harvest had a successful collection. Twenty-three patients underwent stem cell transplantation (SCT) and are evaluable through day 100 with CR/nCR documented in 70% and >or=VGPR in 74%. In conclusion, CyBorD produces a rapid and profound response in patients with newly diagnosed MM with manageable toxicity.

Weekly Regimen

Bortezomib 1.5 mg/m2 SC or IV Days 1, 8, 15, and 22
Cyclophosphamide 300 mg/m2 by mouth, once weekly Days 1, 8, 15, and 22
Dexamethasone	40 mg by mouth, once weekly Days 1, 8, 15, and 22

Reference

Reeder CB, et al. Blood 2010; 115:3416.Full text