The PVd regimen multiple myeloma treatment (pomalidomide, bortezomib, and dexamethasone) offers a promising pathway for patients who have developed resistance to standard therapies. A recent Italian retrospective study examined the real-world outcomes of this combination. The study specifically targeted individuals who were refractory to both lenalidomide and anti-CD38 monoclonal antibodies. Consequently, these findings provide crucial benchmarks for clinical practice in a challenging patient subgroup.

Clinical Efficacy of the PVd Regimen Multiple Myeloma

In this multicentric analysis, the PVd regimen demonstrated a significant overall response rate of approximately 75.8%. Among the 77 patients reviewed, nearly 19% achieved a complete response. Moreover, the median progression-free survival (PFS) reached 9.4 months. These results are particularly encouraging because the study included a high-risk population. Most participants had already undergone one or two previous lines of therapy before becoming double-refractory.

Furthermore, the median overall survival (OS) was recorded at 17.8 months. This indicates that the PVd regimen remains a viable salvage option. Although newer agents like CAR-T cell therapies are emerging, they are not always accessible. Therefore, traditional triplets like PVd remain essential in the daily management of relapsed disease.

Safety and Toxicity Considerations

The safety profile observed in this real-world setting aligned with previous clinical trial data. Neutropenia was the most frequent grade 3 or 4 adverse event. However, clinicians successfully managed most toxicities with standard supportive care. Additionally, the study found that early double-refractory status did not significantly worsen the survival outcomes compared to later progression.

Frequently Asked Questions

What is the PVd regimen?

The PVd regimen consists of three drugs: Pomalidomide (an immunomodulatory agent), Bortezomib (a proteasome inhibitor), and Dexamethasone (a corticosteroid). It is commonly used to treat relapsed or refractory multiple myeloma.

How effective is PVd in double-refractory patients?

Real-world evidence suggests an overall response rate of over 75% in patients refractory to lenalidomide and anti-CD38 antibodies, with a median progression-free survival of approximately 9.4 months.

Disclaimer: This content is for informational and educational purposes only. It does not constitute professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Refer to the latest local and national guidelines for clinical practice.

References

1. Liberatore C et al. Pomalidomide, bortezomib and dexamethasone in multiple myeloma refractory to lenalidomide and anti-CD38 monoclonal antibodies: outcomes from a real-world experience. Haematologica. 2026 Mar 26. doi: 10.3324/haematol.2025.289143. PMID: 41885018.


2. Richardson PG et al. Pomalidomide, bortezomib, and dexamethasone for patients with relapsed or refractory multiple myeloma who received prior lenalidomide (OPTIMISMM): a randomised, open-label, phase 3 trial. Lancet Oncol. 2019;20(6):781-794.