Contributions
Abstract: PB1967
Type: Publication Only
Background
Multiple myeloma (MM) is an incurable plasma cell malignancy, in which aggressive relapses may require salvage cytotoxic infusional chemotherapy. Several clinical trials demonstrating the efficacy of bortezomib led to institutional practice changes where vincristine was replaced with bortezomib in the modified hyperCVAD (mod-CVAD) regimen, creating a new treatment regimen, ‘bortezomib-hyperCAD’ (bort-CVAD).
Aims
The primary objective is to describe the safety and efficacy of the hyperCVAD regimen with vincristine or bortezomib in patients with relapsed or refractory MM treated at Oregon Health and Science University.
Methods
IRB approval was obtained to perform this retrospective analysis. We describe the effectiveness and tolerability of the 2 regimens among 33 patients with relapsed and/or refractory multiple myeloma (RRMM). Patients who received > 1 cycle of mod-CVAD (n= 15) or bort-CVAD (n= 18) from Jan 1 2011 and Dec 31 2015 at the Knight Cancer Institute were included. Most patients were previously treated with/refractory to proteasome inhibitors (97%/76%) or immunomodulatory agents (82%/68%) respectively, 13 received prior autologous stem cell transplant (auto-HCT), the median number of prior lines was 3 (range 1-8). High risk cytogenetic factors t(4;14), t(14;16), or del 17p were present in 8 and extramedullary disease in 13 patients overall.
Results
The median number of cycles given was 2 (range 1-6). Cycles were repeated every 3 to 4 weeks. Median follow up was 48 and 33 months in mod-CVAD and bort-CVAD respectively.
Conclusion
Overall effectiveness and safety outcomes were similar between mod-CVAD and bort-CVAD, with both regimens demonstrating an impressive response rate among heavily pre-treated patients with relapsed/refractory disease. This is a useful salvage strategy to gain rapid disease control; and as a bridge to other therapies including stem cell transplant and novel therapies.
Session topic: 14. Myeloma and other monoclonal gammopathies - Clinical
Keyword(s): Salvage chemotherapy, Myeloma, Cyclophosphamide
Abstract: PB1967
Type: Publication Only
Background
Multiple myeloma (MM) is an incurable plasma cell malignancy, in which aggressive relapses may require salvage cytotoxic infusional chemotherapy. Several clinical trials demonstrating the efficacy of bortezomib led to institutional practice changes where vincristine was replaced with bortezomib in the modified hyperCVAD (mod-CVAD) regimen, creating a new treatment regimen, ‘bortezomib-hyperCAD’ (bort-CVAD).
Aims
The primary objective is to describe the safety and efficacy of the hyperCVAD regimen with vincristine or bortezomib in patients with relapsed or refractory MM treated at Oregon Health and Science University.
Methods
IRB approval was obtained to perform this retrospective analysis. We describe the effectiveness and tolerability of the 2 regimens among 33 patients with relapsed and/or refractory multiple myeloma (RRMM). Patients who received > 1 cycle of mod-CVAD (n= 15) or bort-CVAD (n= 18) from Jan 1 2011 and Dec 31 2015 at the Knight Cancer Institute were included. Most patients were previously treated with/refractory to proteasome inhibitors (97%/76%) or immunomodulatory agents (82%/68%) respectively, 13 received prior autologous stem cell transplant (auto-HCT), the median number of prior lines was 3 (range 1-8). High risk cytogenetic factors t(4;14), t(14;16), or del 17p were present in 8 and extramedullary disease in 13 patients overall.
Results
The median number of cycles given was 2 (range 1-6). Cycles were repeated every 3 to 4 weeks. Median follow up was 48 and 33 months in mod-CVAD and bort-CVAD respectively.
Conclusion
Overall effectiveness and safety outcomes were similar between mod-CVAD and bort-CVAD, with both regimens demonstrating an impressive response rate among heavily pre-treated patients with relapsed/refractory disease. This is a useful salvage strategy to gain rapid disease control; and as a bridge to other therapies including stem cell transplant and novel therapies.
Session topic: 14. Myeloma and other monoclonal gammopathies - Clinical
Keyword(s): Salvage chemotherapy, Myeloma, Cyclophosphamide