POMALIDOMIDE PLUS LOW-DOSE DEXAMETHASONE: A CHANCE FOR RELAPSED AND/OR REFRACTORY MULTIPLE MYELOMA (RRMM). A REVIEW OF A CASE SERIES DIAGNOSED IN A SINGLE CENTER
(Abstract release date: 05/18/17)
EHA Library. Gil Á. 05/18/17; 182736; PB2022
Ángela Gil
Contributions
Contributions
Abstract
Abstract: PB2022
Type: Publication Only
Background
The treatment of patients with multiple myeloma (MM) has dramatically changed over the past decade due in part to the development of new agents and myeloma-specific targets. Nowadays, new effective treatments exist for patients with RRMM not responding to bortezomib and lenalidomide. Pomalidomide alone has shown limited efficacy in patients with RRMM, but synergistic effects have been noted when combined with dexamethasone.
Aims
To show our experience with the use of 28-day cycles of pomalidomide (4 mg/day on days 1–21, orally) plus low-dose dexamethasone (40 mg/day weekly, orally) (Pom/dex) in RRMM.
Methods
This is a retrospective study performed between May 2014 and January 2017 in the Hospital of Guadalajara (Spain). Eight patients (3M, 5F), with a median age of 67 years (range, 40-81), diagnosed with MM were included. Four were classified as high-risk myeloma (Patients 1-4). Patient 1 (P1) had plasma cell leukemia and received Pom/dex plus bortezomib; Patient 2 (P2) presented complex karyotype and received Pom/dex after three previous regimens and an autologous transplantation; Patient 3 and Patient 4 (P3 and P4) had extramedullary plasmacytoma and received Pom/dex ± local radiotherapy. The eight patients of this study had failed to bortezomib and lenalidomide-based therapy, and received Pom/dex until disease progression or unacceptable toxicity. Pom/dex was associated with ciclophosphamide in two patients, and with bortezomib in another two patients. The primary endpoint was progression-free survival (PFS).
Results
The median number of prior regimens was 2 (range, 1-4) and five of eight patients (62.5%) had previously received autologous transplantation. Median time from diagnosis to Pom/dex was 51.5 months (range, 28-155). Patients received a median of 6 cycles of Pom/dex (range, 2-16). In the whole series, the median follow-up was 60.5 months (IQR: 56.0-80.25), and median PFS was 11 months; 75% of patients had not progressed after 5 months, and 50% of patients after 11 months. The overall response rate was 87.5% (only one patient discontinued therapy for non-response).
In standard-risk MM patients, median follow-up was 61 months (IQR: 46.25-140.25), and median PFS was 13 months; 75% of patients had not progressed after 2 months, and 50% of patients after 13 months. Regarding the high-risk group of patients, P1 achieved complete response after 6 cycles of Pom/dex + bortezomib; P2 achieved PFS of 11 months; P3 achieved plasmacytoma resolution after 6 cycles of Pom/dex plus local radiotherapy; P4 abandoned Pom/dex after 3 cycles because of severe neutropenia and sepsis. In this group median follow-up was 60.5 months (IQR: 56.3-79.8), and median PFS was 6 months; 75% of patients had not progressed after 5 months, 50% of patients after 6 months, and 25% of patients after 11 months. Regarding adverse events, they were present in two patients: one had neutropenia, and the second one pneumonia plus pulmonary venous thromboembolism. Both of them died
In standard-risk MM patients, median follow-up was 61 months (IQR: 46.25-140.25), and median PFS was 13 months; 75% of patients had not progressed after 2 months, and 50% of patients after 13 months. Regarding the high-risk group of patients, P1 achieved complete response after 6 cycles of Pom/dex + bortezomib; P2 achieved PFS of 11 months; P3 achieved plasmacytoma resolution after 6 cycles of Pom/dex plus local radiotherapy; P4 abandoned Pom/dex after 3 cycles because of severe neutropenia and sepsis. In this group median follow-up was 60.5 months (IQR: 56.3-79.8), and median PFS was 6 months; 75% of patients had not progressed after 5 months, 50% of patients after 6 months, and 25% of patients after 11 months. Regarding adverse events, they were present in two patients: one had neutropenia, and the second one pneumonia plus pulmonary venous thromboembolism. Both of them died
Conclusion
In our experience, Pom/dex regimen has prolonged PFS of patients with RRMM, with an improvement of health-related quality of life. This regimen has been even valuable in high-risk patients who received Pom/dex after ≥ 2 treatment regimens. Pomalidomide plus low-dose dexamethasone, an oral regimen, could be considered a new treatment option as a standard of care for patients with RRMM who have poor prognosis and a high need for effective treatments.
Session topic: 14. Myeloma and other monoclonal gammopathies - Clinical
Keyword(s): Relapse, Refractory, Myeloma
Abstract: PB2022
Type: Publication Only
Background
The treatment of patients with multiple myeloma (MM) has dramatically changed over the past decade due in part to the development of new agents and myeloma-specific targets. Nowadays, new effective treatments exist for patients with RRMM not responding to bortezomib and lenalidomide. Pomalidomide alone has shown limited efficacy in patients with RRMM, but synergistic effects have been noted when combined with dexamethasone.
Aims
To show our experience with the use of 28-day cycles of pomalidomide (4 mg/day on days 1–21, orally) plus low-dose dexamethasone (40 mg/day weekly, orally) (Pom/dex) in RRMM.
Methods
This is a retrospective study performed between May 2014 and January 2017 in the Hospital of Guadalajara (Spain). Eight patients (3M, 5F), with a median age of 67 years (range, 40-81), diagnosed with MM were included. Four were classified as high-risk myeloma (Patients 1-4). Patient 1 (P1) had plasma cell leukemia and received Pom/dex plus bortezomib; Patient 2 (P2) presented complex karyotype and received Pom/dex after three previous regimens and an autologous transplantation; Patient 3 and Patient 4 (P3 and P4) had extramedullary plasmacytoma and received Pom/dex ± local radiotherapy. The eight patients of this study had failed to bortezomib and lenalidomide-based therapy, and received Pom/dex until disease progression or unacceptable toxicity. Pom/dex was associated with ciclophosphamide in two patients, and with bortezomib in another two patients. The primary endpoint was progression-free survival (PFS).
Results
The median number of prior regimens was 2 (range, 1-4) and five of eight patients (62.5%) had previously received autologous transplantation. Median time from diagnosis to Pom/dex was 51.5 months (range, 28-155). Patients received a median of 6 cycles of Pom/dex (range, 2-16). In the whole series, the median follow-up was 60.5 months (IQR: 56.0-80.25), and median PFS was 11 months; 75% of patients had not progressed after 5 months, and 50% of patients after 11 months. The overall response rate was 87.5% (only one patient discontinued therapy for non-response).
In standard-risk MM patients, median follow-up was 61 months (IQR: 46.25-140.25), and median PFS was 13 months; 75% of patients had not progressed after 2 months, and 50% of patients after 13 months. Regarding the high-risk group of patients, P1 achieved complete response after 6 cycles of Pom/dex + bortezomib; P2 achieved PFS of 11 months; P3 achieved plasmacytoma resolution after 6 cycles of Pom/dex plus local radiotherapy; P4 abandoned Pom/dex after 3 cycles because of severe neutropenia and sepsis. In this group median follow-up was 60.5 months (IQR: 56.3-79.8), and median PFS was 6 months; 75% of patients had not progressed after 5 months, 50% of patients after 6 months, and 25% of patients after 11 months. Regarding adverse events, they were present in two patients: one had neutropenia, and the second one pneumonia plus pulmonary venous thromboembolism. Both of them died
In standard-risk MM patients, median follow-up was 61 months (IQR: 46.25-140.25), and median PFS was 13 months; 75% of patients had not progressed after 2 months, and 50% of patients after 13 months. Regarding the high-risk group of patients, P1 achieved complete response after 6 cycles of Pom/dex + bortezomib; P2 achieved PFS of 11 months; P3 achieved plasmacytoma resolution after 6 cycles of Pom/dex plus local radiotherapy; P4 abandoned Pom/dex after 3 cycles because of severe neutropenia and sepsis. In this group median follow-up was 60.5 months (IQR: 56.3-79.8), and median PFS was 6 months; 75% of patients had not progressed after 5 months, 50% of patients after 6 months, and 25% of patients after 11 months. Regarding adverse events, they were present in two patients: one had neutropenia, and the second one pneumonia plus pulmonary venous thromboembolism. Both of them died
Conclusion
In our experience, Pom/dex regimen has prolonged PFS of patients with RRMM, with an improvement of health-related quality of life. This regimen has been even valuable in high-risk patients who received Pom/dex after ≥ 2 treatment regimens. Pomalidomide plus low-dose dexamethasone, an oral regimen, could be considered a new treatment option as a standard of care for patients with RRMM who have poor prognosis and a high need for effective treatments.
Session topic: 14. Myeloma and other monoclonal gammopathies - Clinical
Keyword(s): Relapse, Refractory, Myeloma
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