Real-World Data from 2200 Patients Backs VRd as Top Myeloma Regimen

Multiple myeloma remains one of the most challenging hematologic malignancies, characterized by clonal plasma cell proliferation in the bone marrow. While clinical trials have driven major advances, they systematically exclude 40–50% of real-world patients due to strict eligibility criteria, leaving a significant evidence gap for practicing clinicians.

This retrospective study analyzed 17 years of national registry data from the Czech Republic, covering more than 2,200 newly diagnosed MM patients who were ineligible for autologous stem cell transplant (ASCT). The central aim was to evaluate the long-term real-world effectiveness of bortezomib-based triplet regimens in routine clinical practice.

The results broadly support bortezomib-lenalidomide-dexamethasone (VRd) as the preferred frontline regimen for transplant-ineligible NDMM patients in the absence of anti-CD38 antibody-based quadruplet therapy. Bortezomib, a proteasome inhibitor approved for relapsed/refractory MM in 2003 and NDMM in 2008, induces apoptosis in malignant plasma cells by disrupting protein degradation pathways and remains central to treatment algorithms worldwide.

The study's large sample size and extended follow-up provide a more representative picture of treatment outcomes than most single-institution or trial-based datasets. It underscores that triplet regimens combining bortezomib with immunomodulatory drugs and corticosteroids deliver meaningful long-term benefit in real-world populations.

Caveats include the retrospective design and reliance on registry data, which may introduce selection bias and inconsistencies in data capture. The findings are also geographically specific to the Czech Republic and may not fully generalize to healthcare systems with different treatment access, patient demographics, or supportive care infrastructure.