Contributions
Abstract: PB2191
Type: Publication Only
Background
Multiple Myeloma (MM) remains an incurable disease despite recent advances in therapy and supportive care. Retreatment for relapsed-refractory multiple myeloma (RRMM) represents one of the therapeutic challenge as well as the change of family drugs. Alkylating drugs have been the standard of care for MM patients (pts) for many years, with melphalan and prednisone (MP) being considered the standard approach for pts not eligible for autologous transplantation. Lenalidomide combined with dexamethasone (Rd) is one of the current standards for treatment of RRMM. However the majority of pts become resistant during the treatment.
Aims
We evaluated the addiction of cyclophosphamide (CRd) in RRMM pts who experienced biochemical relapse during Rd treatment, to slow down the progression in active relapse.
Methods
This analyses included 31 pts with RRMM treated with Rd who received cyclophosphamide at biochemical relapse. Data were collected in 7 Italian Centers of the Multiple Myeloma GIMEMA-Latium Region Working Group. The median age of pts was 70 years (range: 50-86); 15 males and 16 females. The median line of previous treatments was 1 (range: 1-4). Median time from diagnosis to the first CRd cycle was 32.4 months (range: 8.5-187). The CRd regimen was continued in responding pts or in stable disease (SD) until disease progression (PD).
Results
All pts received Rd with a median of 15 cycles (range: 1-52). Responses to Rd were observed in 18 pts (58%), particularly 12 partial responses (PR), 3 very good partial responses (VGPR) and 3 complete rsponses (CR). Three pts maintained a SD. Grade 3/4 side effects were neutropenia (19%), anemia (9.7%), muscle cramps (9.7%), polyneuropathy (9.7%), diarrhea (6.5%), infections (6.5%), esophagitis (3.2%) and rash (3.2%). One patient experienced pulmonary embolism (3.2%). All 31 pts developed a biochemical relapse during Rd treatment, with a median time of 18.5 months (range: 1-49) and received cyclophosphamide without lenalidomide dose modification. The median number of CRd cycles administered was 8 (range: 1-35) and the median time to response after CRd was 2.5 months. A response was observed in 9 (29%) pts, particularly 3 VGPR and 6 PR. Ten patients obtained a SD and 12 a PD. Among the responding pts, 3 are still in therapy with CRd. No correlation between Rd and CRd responses was observed. After a median observation time of 40 months, the median OS from the diagnosis of MM was 78.8 months, while the median OS from the beginning of CRd was 17.7 months. No significant difference in OS was observed between pts treated with 1 or > 1 prior antimyeloma regimen (OS 22.9 months vs. 13.5 months, p= 0.65). The age at diagnosis (> or < 70 years) was not predictive of outcome, with a median OS of 17.7 and 13.8 months for patients > of 70 or < 70 years, respectively (p= 0.94). In addition median time to progression (TTP) was 7.6 months (range: 1-33) and the median PFS from the beginning of CRd was 13.1 months. No additional adverse events were observed by adding cyclophosphamide to Rd. After a median follow up of 11 months (range: 1.3-50.9), there were no treatment-related deaths, but 17 pts (55%) died for progressive myeloma, with a median time of 9.1 months (range: 1-38).
Conclusion
We confirm that Rd is an effective and well tolerated regimen for RRMM pts, inducing a high response rate. However, the addition of oral cyclophosphamide delays the progression in few pts, who present a biochemical relapse during Rd treatment.
Session topic: 14. Myeloma and other monoclonal gammopathies - Clinical
Keyword(s): Cyclophosphamide, Myeloma, Refractory, Relapse
Abstract: PB2191
Type: Publication Only
Background
Multiple Myeloma (MM) remains an incurable disease despite recent advances in therapy and supportive care. Retreatment for relapsed-refractory multiple myeloma (RRMM) represents one of the therapeutic challenge as well as the change of family drugs. Alkylating drugs have been the standard of care for MM patients (pts) for many years, with melphalan and prednisone (MP) being considered the standard approach for pts not eligible for autologous transplantation. Lenalidomide combined with dexamethasone (Rd) is one of the current standards for treatment of RRMM. However the majority of pts become resistant during the treatment.
Aims
We evaluated the addiction of cyclophosphamide (CRd) in RRMM pts who experienced biochemical relapse during Rd treatment, to slow down the progression in active relapse.
Methods
This analyses included 31 pts with RRMM treated with Rd who received cyclophosphamide at biochemical relapse. Data were collected in 7 Italian Centers of the Multiple Myeloma GIMEMA-Latium Region Working Group. The median age of pts was 70 years (range: 50-86); 15 males and 16 females. The median line of previous treatments was 1 (range: 1-4). Median time from diagnosis to the first CRd cycle was 32.4 months (range: 8.5-187). The CRd regimen was continued in responding pts or in stable disease (SD) until disease progression (PD).
Results
All pts received Rd with a median of 15 cycles (range: 1-52). Responses to Rd were observed in 18 pts (58%), particularly 12 partial responses (PR), 3 very good partial responses (VGPR) and 3 complete rsponses (CR). Three pts maintained a SD. Grade 3/4 side effects were neutropenia (19%), anemia (9.7%), muscle cramps (9.7%), polyneuropathy (9.7%), diarrhea (6.5%), infections (6.5%), esophagitis (3.2%) and rash (3.2%). One patient experienced pulmonary embolism (3.2%). All 31 pts developed a biochemical relapse during Rd treatment, with a median time of 18.5 months (range: 1-49) and received cyclophosphamide without lenalidomide dose modification. The median number of CRd cycles administered was 8 (range: 1-35) and the median time to response after CRd was 2.5 months. A response was observed in 9 (29%) pts, particularly 3 VGPR and 6 PR. Ten patients obtained a SD and 12 a PD. Among the responding pts, 3 are still in therapy with CRd. No correlation between Rd and CRd responses was observed. After a median observation time of 40 months, the median OS from the diagnosis of MM was 78.8 months, while the median OS from the beginning of CRd was 17.7 months. No significant difference in OS was observed between pts treated with 1 or > 1 prior antimyeloma regimen (OS 22.9 months vs. 13.5 months, p= 0.65). The age at diagnosis (> or < 70 years) was not predictive of outcome, with a median OS of 17.7 and 13.8 months for patients > of 70 or < 70 years, respectively (p= 0.94). In addition median time to progression (TTP) was 7.6 months (range: 1-33) and the median PFS from the beginning of CRd was 13.1 months. No additional adverse events were observed by adding cyclophosphamide to Rd. After a median follow up of 11 months (range: 1.3-50.9), there were no treatment-related deaths, but 17 pts (55%) died for progressive myeloma, with a median time of 9.1 months (range: 1-38).
Conclusion
We confirm that Rd is an effective and well tolerated regimen for RRMM pts, inducing a high response rate. However, the addition of oral cyclophosphamide delays the progression in few pts, who present a biochemical relapse during Rd treatment.
Session topic: 14. Myeloma and other monoclonal gammopathies - Clinical
Keyword(s): Cyclophosphamide, Myeloma, Refractory, Relapse