CyBorD vs. VRD as Induction Therapy in Multiple Myeloma: A Retrospective Study on Kashmiri Patients

Abstract

Background: Multiple Myeloma (MM) is a clonal plasma cell malignancy that commonly presents with anemia, bone pain, renal dysfunction, and hypercalcemia. While combination regimens like VRD (bortezomib, lenalidomide, dexamethasone) are globally preferred as first-line induction therapy for transplant-eligible patients, real-world data comparing VRD with CyBorD (cyclophosphamide, bortezomib, dexamethasone) remain limited in specific ethnic and resource-constrained settings, including the Kashmiri population.
Objective: To compare the clinical profile, treatment response, and survival outcomes of CyBorD versus VRD as induction regimens in newly diagnosed multiple myeloma patients from Kashmir.
Methods: This retrospective observational study included 101 MM patients treated between January 2015 and June 2022 at a tertiary care center in Kashmir. Patients received either CyBorD (n = 81) or VRD (n = 20). Baseline characteristics, biochemical parameters, response rates, and survival outcomes were analyzed. Kaplan-Meier analysis was used for progression-free survival (PFS) and overall survival (OS).
Results: The median age was 60-years in both groups, with a male predominance. A higher proportion of CyBorD patients presented with ISS Stage III disease (65.4% vs. 40%) and renal dysfunction, reflected by elevated creatinine levels. Lenalidomide, a key component of VRD, was either contraindicated in renal impairment or not freely available during the early study period, influencing treatment selection. The overall response rate (ORR) was comparable between the two regimens (64.3% for CyBorD vs. 68.7% for VRD). The three-year PFS was 67.2% for CyBorD and 60% for VRD. Despite the unequal group sizes, CyBorD showed efficacy even in patients with poor-risk features such as renal impairment.
Conclusion: CyBorD is an effective, accessible, and well-tolerated alternative to VRD in the real-world management of multiple myeloma, especially in patients with renal dysfunction or in settings with limited access to lenalidomide. This study provides valuable regional data and supports the use of CyBorD in resource-constrained environment while highlighting the need for prospective studies with balanced group sizes.