ArticleAnnals of hematology2026
Real-world effectiveness of bortezomib maintenance following VMP induction in transplant-ineligible multiple myeloma: a target trial emulation study.
Article in Annals of hematology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Bortezomib-melphalan-prednisone (VMP) is an established induction regimen for transplant-ineligible newly diagnosed multiple myeloma (NDMM), yet optimal post-induction strategies remain unclear. This study evaluated the effectiveness of bortezomib maintenance following VMP using target trial emulation. We compared a prospective maintenance cohort (KMMWP-174 study) with an external control cohort from a multicenter registry. Eligible patients completed 9 VMP cycles, achieved ≥ partial response, and were progression-free for 60 days. The index date was maintenance initiation for cases and day 60 post-VMP for controls. Propensity score matching (1:1) balanced baseline covariates. The primary endpoint was progression-free survival (PFS); overall survival (OS) was secondary. Sensitivity analyses included multivariable regression, landmark analyses, and E-value assessment. Among 178 eligible patients, 60 comprised the maintenance cohort and 118 the control cohort; 54 per group were analyzed after matching. Median PFS was significantly longer with bortezomib maintenance (26.5 vs. 8.8 months; HR 0.437, 95% CI: 0.275–0.694, P < 0.001). PFS benefits were consistent across subgroups, including patients aged ≥ 70 years, those with ISS stage II-III disease, and those with high-risk cytogenetics. OS showed a favorable trend (HR 0.703, P = 0.252). Grade ≥ 3 adverse events occurred in 31.4% (control) and 18.7% (maintenance). No grade ≥ 3 peripheral neuropathy was observed. Bortezomib maintenance following VMP significantly prolonged PFS in transplant-ineligible NDMM with acceptable toxicity. These real-world data support proteasome inhibitor-based maintenance where VMP remains widely used, particularly among older adults with limited treatment options.
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