# Advantage of Tolerability following Arsenic Trioxide-VTD vs VRD in newly diagnosed multiple myeloma patients: a prospective, open-label study

## TL;DR

A new treatment for multiple myeloma in older patients is safer and cheaper than the standard treatment without losing effectiveness.

## Contribution

The study introduces AVTD as a safer and more cost-effective alternative to VRD for treating multiple myeloma in older patients.

## Key findings

- AVTD showed comparable efficacy to VRD but with significantly fewer infections and bone marrow suppression cases.
- AVTD was associated with lower treatment costs compared to VRD.
- Results were consistent in patients over 60 years old.

## Abstract

Multiple myeloma is the second most common hematologic malignancy in older patients. The standard front-line VRD regimen (bortezomib/lenalidomide/dexamethasone) achieves high efficacy but is associated with significant toxicity, leading to infections, bone marrow suppression, and treatment discontinuation in approximately 20% of patients. Alternative regimens with reduced toxicity are needed for this demographic. Prior studies suggest adding arsenic trioxide to bortezomib/dexamethasone (BD) enhances remission depth with acceptable safety, while bortezomib/thalidomide/dexamethasone (VTD) offers reduced toxicity, but lower efficacy compared to VRD.

This study evaluates the efficacy, safety, and cost-effectiveness of an arsenic trioxide-VTD regimen (AVTD) versus VRD in newly diagnosed multiple myeloma (NDMM) patients. Among 116 participants, AVTD demonstrated comparable efficacy to VRD but significantly reduced infection rates (14.0% vs. 40.7%, P < 0.001) and severe bone marrow suppression (0% vs. 11.9%, P = 0.013). Subgroup analysis of patients >60 years yielded consistent results. Additionally, AVTD was associated with lower treatment costs.

In conclusion, the AVTD regimen offers a safer, more cost-effective alternative to VRD for NDMM, particularly in older adult patients, without compromising treatment efficacy.