RVD with weekly subcutaneous bortezomib minimizes neuropathy and maintains efficacy in a diverse multiple myeloma cohort

Lenalidomide, bortezomib, and dexamethasone (RVD) is standard-of-care induction for fit multiple myeloma patients, with response rate (RR)>90% in first line. Standard RVD utilizes a 21-day cycle with bortezomib IV 1.3 mg/m2 days 1, 4, 8, and 11; lenalidomide 25 mg days 1-14; and dexamethasone 160-320 mg per cycle. Bortezomib-induced neuropathy may be treatment-limiting, occurring in up to 80% of patients. Weekly administration of bortezomib, subcutaneous (SC) dosing, and extending the cycle to 28 or 35 days may optimize tolerance. Those adjustments were studied primarily in transplant-ineligible or relapsed/refractory patients. We report the results of a retrospective analysis of patients who received RVD on a 21-day cycle with weekly subcutaneous bortezomib to improve tolerability or logistics.