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Condition

Multiple Myeloma

Multiple myeloma is a cancer of plasma cells, the antibody-making immune cells in bone marrow, which crowd out healthy blood cells. Evidence is strongest for bortezomib and carfilzomib: trials in relapsed disease found bortezomib produced responses in 38% versus 18% on a steroid, and carfilzomib added to standard drugs extended time without progression from 17.6 to 26.3 months. Motixafortide, also strongly studied, was tested for collecting stem cells before transplant instead.

Sources: PMID 15958804; PMID 29341834

Supplements studied
0
Medicines and peptides
3
Graded outcomes
15
No supplement studies yetWe haven’t found supplement studies for Multiple Myeloma. The medicines and peptides studied for it are listed below.

Prescription medicines and peptides studied, for context

These are not supplements. Most need a prescription, and some are research compounds with no approved use.

3 medicines and peptides

Carfilzomib (Kyprolis)

Carfilzomib (Kyprolis): outcomes studied for Multiple Myeloma
GradeOutcomeEffectSizeStudiesPeopleStudies list
Cardiac Toxicity

SAFETY CONCERN: Heart failure 4-16%, hypertension 9-27%, arrhythmias, QT prolongation (ROR 4.9). FDA FAERS: 38.6% cardiomyopathy-related, 22.7% cardiac failure. Requires baseline cardiac assessment and monitoring.

Worsens (the measure goes up)Moderate effect33 studies

Studies that measured cardiac toxicity

and 30 more on the Carfilzomib (Kyprolis) page

Progression-Free Survival (KRd)

ASPIRE (n=792): Median PFS 26.3 months with KRd vs 17.6 months with Rd (HR 0.69, P<0.001). 8.7 month improvement. Deep responders (≥CR) achieved 50.4 months PFS.

Improves (the measure goes up)Large effect32 studies

Studies that measured progression-free survival (krd)

and 29 more on the Carfilzomib (Kyprolis) page

Overall Survival

ASPIRE final analysis: OS 48.3 vs 40.4 months (HR 0.79, P=0.0045). 7.9 month survival benefit. ENDEAVOR vs bortezomib also showed OS advantage.

Improves (the measure goes up)Moderate effect32 studies

Studies that measured overall survival

and 29 more on the Carfilzomib (Kyprolis) page

PFS vs Bortezomib

ENDEAVOR (n=929): Median PFS 18.7 vs 9.4 months with Kd vs Vd (HR 0.53, P<0.0001). Nearly doubled PFS. Establishes superiority over first-generation proteasome inhibitor.

Improves (the measure goes up)Large effect32 studies

Studies that measured pfs vs bortezomib

and 29 more on the Carfilzomib (Kyprolis) page

Thromboembolism

SAFETY CONCERN: 24% embolic/thrombotic events in FAERS database. DVT prophylaxis recommended. Higher risk than bortezomib. Consider in patients with cardiovascular risk factors.

Worsens (the measure goes down)Moderate effect31 studies

Studies that measured thromboembolism

and 28 more on the Carfilzomib (Kyprolis) page

Bortezomib

Bortezomib: outcomes studied for Multiple Myeloma
GradeOutcomeEffectSizeStudiesPeopleStudies list
Response Rate (Relapsed MM)

APEX (n=669): Combined CR+PR rate 38% with bortezomib vs 18% with high-dose dexamethasone (P<0.001). Superior response in relapsed MM after 1-3 prior therapies.

Improves (the measure goes up)Large effect13 studies

Studies that measured response rate (relapsed mm)

and 10 more on the Bortezomib page

Frontline Treatment (Elderly)

VISTA (n=682): VMP superior to MP in transplant-ineligible patients. Higher response rates, longer TTP, improved OS. Established standard of care for elderly MM.

Improves (the measure goes up)Large effect13 studies

Studies that measured frontline treatment (elderly)

and 10 more on the Bortezomib page

Peripheral Neuropathy

SAFETY CONCERN: Incidence 31-45% in Phase 2/3 trials. Dose-limiting toxicity. Sensory > motor, painful, axonal. Subcutaneous route reduces incidence vs IV. 75-81% reversible with dose modification. Prior neurotoxic therapy increases risk.

Worsens (the measure goes down)Large effect13 studies

Studies that measured peripheral neuropathy

and 10 more on the Bortezomib page

Time to Progression

APEX: Median TTP 6.22 months with bortezomib vs 3.49 months with dexamethasone. Nearly doubled time to progression. VISTA: VMP significantly prolonged TTP vs MP.

Improves (the measure goes up)Moderate effect12 studies

Studies that measured time to progression

and 9 more on the Bortezomib page

Overall Survival

APEX: 1-year survival 80% vs 66% (P=0.003). VISTA: Persistent OS benefit with VMP vs MP maintained at extended follow-up. No increased second malignancy risk.

Improves (the measure goes up)Moderate effect12 studies

Studies that measured overall survival

and 9 more on the Bortezomib page

Thrombocytopenia

SAFETY CONCERN: Common adverse event, cyclical pattern following dosing. Grade 3-4 in 26-30%. Generally recovers during rest periods. May require dose adjustments or transfusions.

Worsens (the measure goes down)Moderate effect12 studies

Motixafortide (Aphexda)

  • Stem Cell Collection Target (Primary): improves
  • CD34+ Cell Yield: improves
  • Safety and Tolerability: improves
Motixafortide (Aphexda): outcomes studied for Multiple Myeloma
GradeOutcomeEffectSizeStudiesPeopleStudies list
Stem Cell Collection Target (Primary)

GENESIS Phase 3 (n=122): 67.5% motixafortide vs 9.5% placebo achieved >=6x10^6 CD34+ cells/kg in 2 apheresis sessions (P<0.0001). By local labs: 92.5% vs 21.4%. Led to FDA approval September 2023.

Improves (the measure goes up)Large effect6 studies

Studies that measured stem cell collection target (primary)

and 3 more on the Motixafortide (Aphexda) page

CD34+ Cell Yield

GENESIS trial: Significantly higher total CD34+ cells mobilized vs placebo. More patients achieved target in first apheresis. Fewer total apheresis sessions required. First new mobilization agent in 15 years.

Improves (the measure goes up)Large effect6 studies

Studies that measured cd34+ cell yield

and 3 more on the Motixafortide (Aphexda) page

Safety and Tolerability

GENESIS trial: Most common AEs (>20%) were injection site reactions, flushing, pruritus, back pain. Serious AEs in 5.4%. Manageable safety profile. No increased risks vs standard mobilization.

Improves (the measure goes up)Moderate effect3 studies

Studies that measured safety and tolerability

Allogeneic Donor Mobilization

Allogeneic donor study: 92% (22/24) achieved >=2.0x10^6 CD34+ cells/kg in 2 leukapheresis. 100% (11/11) at 1.25 mg/kg dose. Single injection regimen offers convenience vs repeated plerixafor dosing.

Improves (the measure goes up)Large effect6 studies

Studies that measured allogeneic donor mobilization

and 3 more on the Motixafortide (Aphexda) page

Key findings

  • Cardiac ToxicityCarfilzomib (Kyprolis)Worsens (the measure goes up)
  • Progression-Free Survival (KRd)Carfilzomib (Kyprolis)Improves (the measure goes up)
  • Overall SurvivalCarfilzomib (Kyprolis)Improves (the measure goes up)

Safety notes in the studies

  • Higher risk than bortezomib.
  • Consider in patients with cardiovascular risk factors.
  • Dose-limiting toxicity.

Studies cited

56 studies from PubMed

  1. Small molecule and peptide CXCR4 antagonists. A patent review from 2019 to 2024.Expert opinion on therapeutic patents, 2025 · PMID 39925185
  2. Health-Related Quality of Life in Patients With Relapsed/Refractory Multiple Myeloma Treated With Carfilzomib, Dexamethasone, and Daratumumab Versus Carfilzomib and Dexamethasone: An Analysis of Patient-Reported Outcomes From the Phase 3 CANDOR Trial.Clinical lymphoma, myeloma & leukemia, 2025 · PMID 40087058
  3. A comparative review of Aphexda and Mozobil for mobilization prior to stem cell collection.Journal of oncology pharmacy practice : official publication of the International Society of Oncology Pharmacy Practitioners, 2024 · PMID 38629183
  4. Proteasome inhibitors related thrombotic microangiopathy: a systematic and comprehensive review.Blood cancer journal, 2024 · PMID 39511171
  5. Carfilzomib-induced thrombotic microangiopathy (TMA) refractory to eculizumab: A case report and literature review.Annals of hematology, 2024 · PMID 39191958
  6. Isatuximab plus carfilzomib-dexamethasone versus carfilzomib-dexamethasone in patients with relapsed multiple myeloma (IKEMA): overall survival analysis of a phase 3, randomised, controlled trial.The Lancet. Haematology, 2024 · PMID 39067465
  7. Comparative efficacy of carfilzomib, lenalidomide, and dexamethasone (KRd) versus bortezomib, lenalidomide, and dexamethasone (VRd) in newly-diagnosed multiple myeloma: A systematic review and meta-analysis.American journal of hematology, 2024 · PMID 38606993
  8. An open-label phase 2 study treating patients with first or second relapse of multiple myeloma with carfilzomib, pomalidomide, and dexamethasone (KPd): SELECT study.Leukemia & lymphoma, 2024 · PMID 38497533
  9. Carfilzomib-induced Thrombotic Microangiopathy: A Case Based Review.Hematology/oncology and stem cell therapy, 2023 · PMID 32735793
  10. Selinexor-Bortezomib-Dexamethasone: A Review in Previously Treated Multiple Myeloma.Targeted oncology, 2023 · PMID 36622630
  11. Innovations in hematopoietic stem-cell mobilization: a review of the novel CXCR4 inhibitor motixafortideTher Adv Hematol, 2023 · PMID 37250913
  12. Motixafortide and G-CSF to mobilize hematopoietic stem cells for autologous transplantation in multiple myeloma: a randomized phase 3 trialNat Med, 2023 · PMID 37069359
  13. Carfilzomib-induced thrombotic microangiopathy is underestimated in clinical practice: A report of five patients and literature review.Leukemia & lymphoma, 2022 · PMID 35373680
  14. Carfilzomib and dexamethasone maintenance following salvage ASCT in multiple myeloma: A randomised phase 2 trial by the Nordic Myeloma Study Group.European journal of haematology, 2022 · PMID 34536308
  15. Foot drop in patients treated with bortezomib - a case series and review of the literature.Leukemia & lymphoma, 2022 · PMID 34702127
  16. Carfilzomib with cyclophosphamide and dexamethasone or lenalidomide and dexamethasone plus autologous transplantation or carfilzomib plus lenalidomide and dexamethasone, followed by maintenance with carfilzomib plus lenalidomide or lenalidomide alone for patients with newly diagnosed multiple myeloma (FORTE): a randomised, open-label, phase 2 trial.The Lancet. Oncology, 2021 · PMID 34774221
  17. Isatuximab, carfilzomib, and dexamethasone in relapsed multiple myeloma (IKEMA): a multicentre, open-label, randomised phase 3 trial.Lancet (London, England), 2021 · PMID 34097854
  18. Efficacy and safety profile of deep responders to carfilzomib-based therapy: a subgroup analysis from ASPIRE and ENDEAVORLeukemia, 2021 · PMID 33067574
  19. Carfilzomib, dexamethasone, and daratumumab versus carfilzomib and dexamethasone for patients with relapsed or refractory multiple myeloma (CANDOR): results from a randomised, multicentre, open-label, phase 3 study.Lancet (London, England), 2020 · PMID 32682484
  20. Infection risk with carfilzomib in multiple myeloma: a systematic review and meta-analysis of randomised controlled trials.British journal of haematology, 2020 · PMID 32400886
  21. Venetoclax in combination with carfilzomib and dexamethasone in relapsed/refractory multiple myeloma harboring t(11,14)(q13;q32): two case reports and a review of the literature.Journal of medical case reports, 2020 · PMID 32321588
  22. Bortezomib-based consolidation or maintenance therapy for multiple myeloma: a meta-analysis.Blood cancer journal, 2020 · PMID 32144237
  23. Population-based meta-analysis of bortezomib exposure-response relationships in multiple myeloma patients.Journal of pharmacokinetics and pharmacodynamics, 2020 · PMID 31939004
  24. Carfilzomib: A Tale of a Heartbreaking Moment: Case Report and Concise Review of the Literature.Cardiovascular & hematological disorders drug targets, 2019 · PMID 30516116
  25. Subcutaneous bortezomib might be standard of care for patients with multiple myeloma: a systematic review and meta-analysis.Drug design, development and therapy, 2019 · PMID 31190749
  26. Once weekly versus twice weekly carfilzomib dosing in patients with relapsed and refractory multiple myeloma (A.R.R.O.W.): interim analysis results of a randomised, phase 3 study.The Lancet. Oncology, 2018 · PMID 29866475
  27. Subcutaneous versus Intravenous Bortezomib Administration for Multiple Myeloma Patients: a Meta-analysis.Current medical science, 2018 · PMID 30074150
  28. Carfilzomib in relapsed or refractory multiple myeloma patients with early or late relapse following prior therapy: A subgroup analysis of the randomized phase 3 ASPIRE and ENDEAVOR trialsHematol Oncol, 2018 · PMID 29446103
  29. Analysis of carfilzomib cardiovascular safety profile across relapsed and/or refractory multiple myeloma clinical trialsBlood Adv, 2018 · PMID 29991494
  30. Carfilzomib-Associated Cardiovascular Adverse Events: A Systematic Review and Meta-analysisJAMA Oncol, 2018 · PMID 29285538
  31. Improvement in Overall Survival With Carfilzomib, Lenalidomide, and Dexamethasone in Patients With Relapsed or Refractory Multiple MyelomaJ Clin Oncol, 2018 · PMID 29341834
  32. Carfilzomib-containing combinations as frontline therapy for multiple myeloma: A meta-analysis of 13 trials.European journal of haematology, 2017 · PMID 28295593
  33. Carfilzomib/pomalidomide single-agent or in combination with other agents for the management of relapsed/refractory multiple myeloma: a meta-analysis of 37 trials.Oncotarget, 2017 · PMID 27458170
  34. Weekly versus biweekly bortezomib given in patients with indolent non-Hodgkin lymphoma: A meta-analysis.PloS one, 2017 · PMID 28531181
  35. Carfilzomib or bortezomib in relapsed or refractory multiple myeloma (ENDEAVOR): an interim overall survival analysis of an open-label, randomised, phase 3 trialLancet Oncol, 2017 · PMID 28843768
  36. Efficacy of carfilzomib in the treatment of relapsed and (or) refractory multiple myeloma: a meta-analysis of data from clinical trials.Discovery medicine, 2016 · PMID 27875670
  37. Carfilzomib Triple Combination Therapy: A Review in Relapsed Multiple Myeloma.Targeted oncology, 2016 · PMID 26972294
  38. A practical review on carfilzomib in multiple myeloma.European journal of haematology, 2016 · PMID 26893241
  39. Management of Carfilzomib-Associated Cardiac Adverse EventsClin Lymphoma Myeloma Leuk, 2016 · PMID 26907720
  40. Carfilzomib and dexamethasone versus bortezomib and dexamethasone for patients with relapsed or refractory multiple myeloma (ENDEAVOR): a randomised, phase 3, open-label, multicentre studyLancet Oncol, 2016 · PMID 26671818
  41. Carfilzomib, lenalidomide, and dexamethasone for relapsed multiple myelomaN Engl J Med, 2015 · PMID 25482145
  42. Meta-analysis of incidence and risk of peripheral neuropathy associated with intravenous bortezomibSupport Care Cancer, 2015 · PMID 25676487
  43. Bortezomib in combination with thalidomide or lenalidomide or doxorubicin regimens for the treatment of multiple myeloma: a meta-analysis of 14 randomized controlled trials.Leukemia & lymphoma, 2014 · PMID 23998282
  44. Integrated safety profile of single-agent carfilzomib: experience from 526 patients enrolled in 4 phase II clinical studiesHaematologica, 2013 · PMID 23935022
  45. Persistent overall survival benefit and no increased risk of second malignancies with bortezomib-melphalan-prednisone versus melphalan-prednisone in patients with previously untreated multiple myelomaJ Clin Oncol, 2013 · PMID 23233713
  46. Bortezomib plus melphalan and prednisone compared with melphalan and prednisone in previously untreated multiple myeloma: updated follow-up and impact of subsequent therapy in the phase III VISTA trialJ Clin Oncol, 2010 · PMID 20368561
  47. Plerixafor, a CXCR4 antagonist for the mobilization of hematopoietic stem cellsExpert Opin Investig Drugs, 2009 · PMID 18847313
  48. Bortezomib: a review of its use in patients with multiple myelomaDrugs, 2009 · PMID 19441872
  49. Extended follow-up of a phase 3 trial in relapsed multiple myeloma: final time-to-event results of the APEX trialBlood, 2007 · PMID 17690257
  50. Bortezomib-induced peripheral neuropathy in multiple myeloma: a comprehensive review of the literatureJ Clin Oncol, 2006 · PMID 18574024
  51. Bortezomib or high-dose dexamethasone for relapsed multiple myelomaN Engl J Med, 2005 · PMID 15958804
  52. Role of Vitamin D Supplementation in Chronic Liver Disease: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.Nutr Rev · PMID 40644459
  53. Does tauroursodeoxycholic acid (TUDCA) treatment increase hepatocyte proliferation in patients with chronic liver diseaseItal J Gastroenterol · PMID 8541578
  54. S-adenosyl-L-methionine for the treatment of chronic liver disease: a systematic review and meta-analysisPLoS One · PMID 25774783
  55. S-adenosyl-L-methionine for treatment of depression, osteoarthritis, and liver disease.Evid Rep Technol Assess · PMID 12899148
  56. The effects of acute doses of nicotine on video lottery terminal gambling in daily smokersPsychopharmacology · PMID 21904819