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March 17, 2016
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Sequential vs alternating administration of VMP and Rd in elderly patients with newly diagnosed MM

Publicated to:Blood. 127 (4): 420-425 - 2016-01-28 127(4), DOI: 10.1182/blood-2015-08-666537

Authors: Mateos, Maria-Victoria; Martinez-Lopez, Joaquin; Hernandez, Miguel-Teodoro; Ocio, Enrique-M; Rosinol, Laura; Martinez, Rafael; Teruel, Ana-Isabel; Gutierrez, Norma C; Ramos, Maria-Luisa Martin; Oriol, Albert; Bargay, Joan; Bengoechea, Enrique; Gonzalez, Yolanda; Perez de Oteyza, Jaime; Gironella, Mercedes; Encinas, Cristina; Martin, Jesus; Cabrera, Carmen; Paiva, Bruno; Cedena, Maria-Teresa; Puig, Noemi; Blade, Joan; Lahuerta, Juan-Jose; San-Miguel, Jesus

Affiliations

- Author
and. - Author
Clínica Universidad de Navarra, Centro de Investigación Médica Aplicada (CIMA), Instituto de Investigación Sanitaria de Navarra (IDISNA), Pamplona, Spain. - Author
Complejo Asistencial Univ Salamanca, Inst Invest Biomed Salamanca CAUSA IBSAL, Salamanca, Spain - Author
Complejo Asistencial Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca (CAUSA/IBSAL), Salamanca, Spain - Author
Hosp Clin Barcelona, IDIBAPS, Barcelona, Spain - Author
Hosp Clin San Carlos, Madrid, Spain - Author
Hosp Clin Valencia, Valencia, Spain - Author
Hosp Donostia, San Sebastian, Spain - Author
Hosp Gen Univ Gregorio Maranon, Inst Invest Sanitaria Gregorio Maranon IiSGM, Madrid, Spain - Author
Hosp Gen Virgen del Rocio, Seville, Spain - Author
Hosp Germans Trials & Pujol, Inst Josep Carreras, Inst Catala Oncol, Barcelona, Spain - Author
Hosp San Pedro de Alcantara, Caceres, Spain - Author
Hosp Son Llatzer, Palma De Mallorca, Spain - Author
Hosp Univ 12 Octubre, Inst Invest Octubre 12, Madrid, Spain - Author
Hosp Univ Canarias, Santa Cruz De Tenerife, Spain - Author
Hosp Valle De Hebron, Barcelona, Spain - Author
Hospital Clinic i Provincial, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain - Author
Hospital Clínico de Valencia, Valencia, Spain - Author
Hospital Clinico San Carlos, Madrid, Spain - Author
Hospital de Donostia, San Sebastian, Spain - Author
Hospital de Madrid Sanchinarro, Universidad Centro de Estudios Universitarios San Pablo, Madrid, Spain - Author
Hospital General Universitario Gregorio Marañón, Instituto de Investigacion Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain - Author
Hospital General Virgen del Rocío, Sevilla, Spain - Author
Hospital San Pedro de Alcantara, Cáceres, Spain - Author
Hospital Son Llatzer, Palma de Mallorca, Spain - Author
Hospital Universitario 12 de Octubre, Instituto de investigación 12 de Octubre, Madrid, Spain - Author
Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain - Author
Hospital Vall d'Hebrón, Barcelona, Spain - Author
Inst Oncol Dr Josep Trueta, Girona, Spain - Author
Institut Català d'Oncologia, Institut Josep Carreras, Hospital Germans Trials i Pujol, Badalona, Barcelona, Spain - Author
Institut d'Oncologia Dr. Josep Trueta, Girona, Spain - Author
Univ Ctr Estudios Univ San Pablo, Hosp Madrid Sanchinarro, Madrid, Spain - Author
Univ Navarra Clin, Inst Invest Sanitaria Navarra IDISNA, CIMA, Pamplona, Spain - Author
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Abstract

Bortezomib plus melphalan and prednisone (VMP) and lenalidomide plus low-dose dexamethasone (Rd) are 2 standards of care for elderly untreated multiple myeloma (MM) patients. We planned to use VMP and Rd for 18 cycles in a sequential or alternating scheme. Patients (233) with untreated MM, >65 years, were randomized to receive 9 cycles of VMP followed by 9 cycles of Rd (sequential scheme; n = 118) vs 1 cycle of VMP followed by 1 cycle of Rd, and so on, up to 18 cycles (alternating scheme; n = 115). VMP consisted of one 6-week cycle of bortezomib using a biweekly schedule, followed by eight 5-week cycles of once-weekly VMP. Rd included nine 4-week cycles of Rd. The primary end points were 18-month progression free survival (PFS) and safety profile of both schemes. The 18-month PFS was 74% and 80% in the sequential and alternating arms, respectively (P = .21). The sequential and alternating groups exhibited similar hematologic and nonhematologic toxicity. Both arms yielded similar complete response rate (42% and 40%), median PFS (32 months vs 34 months, P = .65), and 3-year overall survival (72% vs 74%, P = .63). The benefit of both schemes was remarkable in patients aged 65 to 75 years. In addition, achieving complete and immunophenotypic response was associated with better outcome. The present approach, based on VMP and Rd, is associated with high efficacy and acceptable toxicity profile with no differences between the sequential and alternating regimens. This trial was registered at www.clinicaltrials.gov as #NCT00443235. © 2016 by The American Society of Hematology.

Keywords

Bortezomib-melphalan-prednisoneClinical-trialsInductionInitial treatmentLenalidomideMaintenanceMultiple-myeloma patientsSurvivalThalidomideTherapy

Quality index

Bibliometric impact. Analysis of the contribution and dissemination channel

The work has been published in the journal Blood due to its progression and the good impact it has achieved in recent years, according to the agency WoS (JCR), it has become a reference in its field. In the year of publication of the work, 2016, it was in position 2/70, thus managing to position itself as a Q1 (Primer Cuartil), in the category Hematology.

From a relative perspective, and based on the normalized impact indicator calculated from World Citations provided by WoS (ESI, Clarivate), it yields a value for the citation normalization relative to the expected citation rate of: 1.39. This indicates that, compared to works in the same discipline and in the same year of publication, it ranks as a work cited above average. (source consulted: ESI Nov 14, 2024)

This information is reinforced by other indicators of the same type, which, although dynamic over time and dependent on the set of average global citations at the time of their calculation, consistently position the work at some point among the top 50% most cited in its field:

  • Weighted Average of Normalized Impact by the Scopus agency: 1.38 (source consulted: FECYT Feb 2024)
  • Field Citation Ratio (FCR) from Dimensions: 12.09 (source consulted: Dimensions Jul 2025)

Specifically, and according to different indexing agencies, this work has accumulated citations as of 2025-07-06, the following number of citations:

  • WoS: 49
  • Scopus: 48
  • Europe PMC: 32

Impact and social visibility

From the perspective of influence or social adoption, and based on metrics associated with mentions and interactions provided by agencies specializing in calculating the so-called "Alternative or Social Metrics," we can highlight as of 2025-07-06:

  • The use, from an academic perspective evidenced by the Altmetric agency indicator referring to aggregations made by the personal bibliographic manager Mendeley, gives us a total of: 102.
  • The use of this contribution in bookmarks, code forks, additions to favorite lists for recurrent reading, as well as general views, indicates that someone is using the publication as a basis for their current work. This may be a notable indicator of future more formal and academic citations. This claim is supported by the result of the "Capture" indicator, which yields a total of: 102 (PlumX).

With a more dissemination-oriented intent and targeting more general audiences, we can observe other more global scores such as:

  • The Total Score from Altmetric: 3.35.
  • The number of mentions on the social network X (formerly Twitter): 7 (Altmetric).

Leadership analysis of institutional authors

This work has been carried out with international collaboration, specifically with researchers from: United States of America.