Pomalidomide in Combination with Low-Dose Dexamethasone as the Treatment of “Double Refractory” Multiple Myeloma
Background. The development of radical therapy for multiple myeloma (MM) is still a pressing problem. This progressive disease requires repeated courses of therapy using drugs without cross-resistance. The prognosis of “double refractory” MM which is resistant to key antitumor drugs, first generatio...
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| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | Russian |
| Published: |
Practical Medicine Publishing House
2017-07-01
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| Series: | Клиническая онкогематология |
| Subjects: | |
| Online Access: | http://bloodjournal.ru/wp-content/uploads/2017/09/10.pdf |
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| Summary: | Background. The development of radical therapy for multiple myeloma (MM) is still a pressing problem. This progressive disease requires repeated courses of therapy using drugs without cross-resistance. The prognosis of “double refractory” MM which is resistant to key antitumor drugs, first generation protease inhibitors and immunomodulating agents, remains poor. The median progression-free survival (PFS) and overall survival (OS) in this cohort of patients are 5 and 9 months, respectively.
Aim. The aim was to assess the effectiveness and tolerability of pomalidomide in combination with low-dose of dexamethasone in “double refractory” relapsed/refractory multiple myeloma (RRMM).
Materials & Methods. According to study protocol, 10 patients from Hematology Research Center and Federal Almazov North-West Medical Research Centre with RRMM were included in the period from September 2015 to July 2016. The median age was 62.5 years (range 48–76 years), and the median number of therapy lines was 4 (range 3–5). All patients had a disease progression after the administration of bortezomib, lenalidomide, and alkylating agents. In addition, 6 (60 %) of 10 patients received high-dose melphalan chemotherapy followed by auto-HSCT. The median number of therapy lines was 6 (range 4–15).
Results. The overall response rate was 60 % and the minimum response (stabilization of the disease) was observed in 40 % of patients (IMWG criteria). The median PFS was 7.8 months; OS in 18 months was observed in 70 % of cases (the median not achieved). Treatment-associated grade III–IV hematologic toxicity was observed in 2 patients (5 episodes). Non-hematological adverse events of grade III–IV included acute coronary syndrome, deep vein thrombosis, neuropathic pain, and in 1 case acute delusional disorder, which required discontinuation of the therapy. The presence of initial cytopenia and renal failure before therapy with pomalidomide did not require the dosage reduction or discontinuation of treatment.
Conclusion. Pomalidomide with low-dose dexamethasone demonstrated a high overall response rate an acceptable toxicity profile in patients with RRMM. |
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| ISSN: | 1997-6933 2500-2139 |