Pomalidomide, bortezomib, and dexamethasone for newly diagnosed multiple myeloma patients with renal impairment

Renal impairment (RI) is a frequent complication of multiple myeloma (MM), affecting 20% to 40% of patients with newly diagnosed MM (NDMM), and it is considered to be independently associated with adverse survival outcomes for patients with myeloma.(1-3) Because renal recovery could be associated with improved survival,(4,5) more effective antimyeloma treatments that could also improve renal function are urgently needed for such patients. Although the combination of bortezomib-lenalidomidedexamethasone (VRD) was recommended as frontline therapy for most patients with NDMM,(6) it is not adequate as frontline therapy for patients with MM-RI because lenalidomide should be given with dose reduction that might result in underdosing.(7,8) Other bortezomib-based triplet regimens (doxorubicin, cyclophosphamide, or thalidomide with dexamethasone) have been recommended for MM with RI by the International Myeloma Working Group (IMWG).(9) However, standard recommendation is still lacking. Pomalidomide has been proven to be tolerable and effective in patients with severe RI and is not required for dose adjustment.(10) The pomalidomide-bortezomib-dexamethasone (PVD) combination has been approved in relapsed/refractory MM (R/R MM) based on the results of phase 3 OPTIMISMM trial11 and has also shown high efficacy in patients with NDMM.(12) However, prospective data on PVD in patients with RI are still lacking. This study was aimed to evaluate the renal response of PVD in NDMM with RI.