Contributions
Abstract: PB1976
Type: Publication Only
Background
New agents have revolutionised the treatment of multiple myeloma. Immunomodulatory drugs (IMiD) such as lenalidomide and pomalidomide are potent re-induction drugs leading to improved Progression Free Survival (PFS) and Overall survival (OS). Published studies include exclusion criteria such as cytopenias, renal dysfunction and poor performance status (common in multi-relapsed patients), raising the question regarding the benefit of IMiD therapy in the real-world setting.
Aims
In our study we aimed to describe the real-world experience of the use of lenalidamide followed by pomalidamide rescue in a relatively elderly co-morbid cohort over a 4 year period and compare this to national averages. We reviewed IMiD efficacy, including sequential lenalidomide followed by pomalidomide, together with tolerance.
Methods
Records of delivered chemotherapy cycles were retrieved from local pharmacy data and national averages from Celgene ePAF data. Outcome data collected from clinical notes and laboratory results.
Results
We collected data on 46 patients treated between 2011-2014 with lenalidomide, 17 whom progressed to recieve pomalidomide. The median age at initial myeloma diagnosis was 71 years, with median age at starting lenalidomide 77years (range 36-94). This gave an average of 5 years from diagnosis to commencing lenalidomide (range 1-15 years). Myeloma subtypes included IgG 28/46, IgA 11/46, light chain disease 4/46 and 3 with IgD and non-secretory myeloma. High risk cytogenetics [17p-, t(4:16), t(4:20), hypodiploidy, chromosome 1 abnormalities] were identified in 9/46 and 16/46 were high-risk based on biomarker staging (ISS). All patients had at least 1 preceding line of therapy before starting lenalidomide, average 2 lines (range 1-6). Prior treatment included alkylating agents/steroid duplets, thalidomide combinations, bortezomib-based therapy and autograft. National average for the % of patients reaching cycle 26 was 16% comparing to the local average of 31%. This included patients receiving 5mg due to severe renal impairment or cytopenias. In the patient group between 65-75 years of age, 50% reached cycle 26 compared to the national average of 16%. Average duration on treatment was 15 months. (Local-cohort). Lenalidomide-treatment breaks occurred in 16 patients with a median of 5 months (infection, cytopenias, liver dysfunction, foreign travel, other). Cytopenias or infections were seen in 45% of local patients with 28% of patients having subsequent dose reductions. Based on performance status, renal function and prior drug tolerability, only 30% of patients were prescribed lenalidomide 25mg od. Despite this 17 patients (36%) achieved a prolonged PFS of >20 months and 13/46 (30%) a PFS of >30 months. The longest observed PFS in the local cohort was 53 months. The average number of cycles in those who progressed to pomalidomide was 12.8 (n=17), which is double that of the national average reported in seminal trials. These patients had few treatment breaks and treatment was well tolerated (pomalidomide duplets or triplets).
Conclusion
We conclude from this real-world retrospective review of 2nd and 3rd line IMiD therapy that these salvage regimes are highly effective. Patients on lenalidomide monotherapy post triplet/duplet induction were often re-escalated back onto dexamethasone and alkylator (IV/oral) based regimes with successful salvage, contributing to the observed long duration of local therapy compared to national averages. Pomalidomide was highly effective at rescuing patients failing lenalidomide-based regimes and well tolerated.
Session topic: 14. Myeloma and other monoclonal gammopathies - Clinical
Keyword(s): Relapse, Myeloma, Clinical outcome, tolerance
Abstract: PB1976
Type: Publication Only
Background
New agents have revolutionised the treatment of multiple myeloma. Immunomodulatory drugs (IMiD) such as lenalidomide and pomalidomide are potent re-induction drugs leading to improved Progression Free Survival (PFS) and Overall survival (OS). Published studies include exclusion criteria such as cytopenias, renal dysfunction and poor performance status (common in multi-relapsed patients), raising the question regarding the benefit of IMiD therapy in the real-world setting.
Aims
In our study we aimed to describe the real-world experience of the use of lenalidamide followed by pomalidamide rescue in a relatively elderly co-morbid cohort over a 4 year period and compare this to national averages. We reviewed IMiD efficacy, including sequential lenalidomide followed by pomalidomide, together with tolerance.
Methods
Records of delivered chemotherapy cycles were retrieved from local pharmacy data and national averages from Celgene ePAF data. Outcome data collected from clinical notes and laboratory results.
Results
We collected data on 46 patients treated between 2011-2014 with lenalidomide, 17 whom progressed to recieve pomalidomide. The median age at initial myeloma diagnosis was 71 years, with median age at starting lenalidomide 77years (range 36-94). This gave an average of 5 years from diagnosis to commencing lenalidomide (range 1-15 years). Myeloma subtypes included IgG 28/46, IgA 11/46, light chain disease 4/46 and 3 with IgD and non-secretory myeloma. High risk cytogenetics [17p-, t(4:16), t(4:20), hypodiploidy, chromosome 1 abnormalities] were identified in 9/46 and 16/46 were high-risk based on biomarker staging (ISS). All patients had at least 1 preceding line of therapy before starting lenalidomide, average 2 lines (range 1-6). Prior treatment included alkylating agents/steroid duplets, thalidomide combinations, bortezomib-based therapy and autograft. National average for the % of patients reaching cycle 26 was 16% comparing to the local average of 31%. This included patients receiving 5mg due to severe renal impairment or cytopenias. In the patient group between 65-75 years of age, 50% reached cycle 26 compared to the national average of 16%. Average duration on treatment was 15 months. (Local-cohort). Lenalidomide-treatment breaks occurred in 16 patients with a median of 5 months (infection, cytopenias, liver dysfunction, foreign travel, other). Cytopenias or infections were seen in 45% of local patients with 28% of patients having subsequent dose reductions. Based on performance status, renal function and prior drug tolerability, only 30% of patients were prescribed lenalidomide 25mg od. Despite this 17 patients (36%) achieved a prolonged PFS of >20 months and 13/46 (30%) a PFS of >30 months. The longest observed PFS in the local cohort was 53 months. The average number of cycles in those who progressed to pomalidomide was 12.8 (n=17), which is double that of the national average reported in seminal trials. These patients had few treatment breaks and treatment was well tolerated (pomalidomide duplets or triplets).
Conclusion
We conclude from this real-world retrospective review of 2nd and 3rd line IMiD therapy that these salvage regimes are highly effective. Patients on lenalidomide monotherapy post triplet/duplet induction were often re-escalated back onto dexamethasone and alkylator (IV/oral) based regimes with successful salvage, contributing to the observed long duration of local therapy compared to national averages. Pomalidomide was highly effective at rescuing patients failing lenalidomide-based regimes and well tolerated.
Session topic: 14. Myeloma and other monoclonal gammopathies - Clinical
Keyword(s): Relapse, Myeloma, Clinical outcome, tolerance