Lenalidomide and dexamethasone with bortezomib (VRd) or carfilzomib (KRd) are commonly used induction regimens in the U.S. This single-center, retrospective study evaluated outcomes and safety of VRd and KRd. Primary endpoint was progression-free survival (PFS). Of 389 patients with newly diagnosed multiple myeloma, 198 received VRd and 191 received KRd. Median PFS was not reached (NR) in both groups; 5-year PFS was 56% (95%CI, 48–64%) for VRd and 67% (60–75%) for KRd (P = 0.027). Estimated 5-year EFS was 34% (95%CI, 27–42%) for VRd and 52% (45–60%) for KRd (P < 0.001) with corresponding 5-year OS of 80% (95%CI, 75–87%) and 90% (85–95%), respectively (P = 0.053). For standard-risk patients, 5-year PFS was 68% (95%CI, 60–78%) for VRd and 75% (65–85%) for KRd (P = 0.20) with 5-year OS of 87% (95%CI, 81–94%) and 93% (87–99%), respectively (P = 0.13). For high-risk patients, median PFS was 41 months (95%CI, 32.8–61.1) for VRd and 70.9 months (58.2-NR) for KRd (P = 0.016). Respective 5-year PFS and OS were 35% (95%CI, 24–51%) and 69% (58–82%) for VRd and 58% (47–71%) and 88% (80–97%, P = 0.044) for KRd. Overall, KRd resulted in improved PFS and EFS with a trend toward improved OS compared to VRd with associations primarily driven by improvements in outcome for high-risk patients.
来那度胺联合地塞米松以及硼替佐米（VRd方案）或卡非佐米（KRd方案）是美国常用的诱导治疗方案。这项单中心回顾性研究评估了VRd与KRd方案的疗效与安全性，主要终点为无进展生存期（PFS）。在389例新诊断的多发性骨髓瘤患者中，198例接受VRd治疗，191例接受KRd治疗。两组中位PFS均未达到（NR）；VRd组5年PFS为56%（95%CI, 48–64%），KRd组为67%（60–75%）（P=0.027）。VRd组估计5年EFS为34%（95%CI, 27–42%），KRd组为52%（45–60%）（P<0.001），对应的5年OS分别为80%（95%CI, 75–87%）和90%（85–95%）（P=0.053）。在标危患者中，VRd组5年PFS为68%（95%CI, 60–78%），KRd组为75%（65–85%）（P=0.20），5年OS分别为87%（95%CI, 81–94%）和93%（87–99%）（P=0.13）。在高危患者中，VRd组中位PFS为41个月（95%CI, 32.8–61.1），KRd组为70.9个月（58.2-NR）（P=0.016）；VRd组5年PFS和OS分别为35%（95%CI, 24–51%）和69%（58–82%），KRd组分别为58%（47–71%）和88%（80–97%, P=0.044）。总体而言，与VRd方案相比，KRd方案显著改善了PFS和EFS，并显示出OS改善趋势，这种关联主要源于高危患者预后的提升。
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