Division of Oncology, Department of Medicine, Washington University School of Medicine, 660 S Euclid Ave, Box 8056, St. Louis, MO, 63110, USA.
Ann Hematol. 2020 May;99(5):1041-1048. doi: 10.1007/s00277-020-03970-2. Epub 2020 Mar 4.
Multiple myeloma (MM) almost invariably progresses through novel therapies. Patients with quad-refractory MM (refractory to bortezomib, carfilzomib, lenalidomide, and pomalidomide) and penta-refractory MM (additional refractoriness to daratumumab) have few treatment options. Two chemotherapy regimens, bendamustine/prednisone (BP) and dexamethasone, cyclophosphamide, etoposide, and cisplatin (DCEP), are often used in quad- and penta-refractory MM, but there are limited data on outcomes in this heavily pre-treated population. We conducted a single-center retrospective study to identify all patients who received DCEP and/or BP for quad- or penta-refractory MM. Disease response and refractoriness were defined by International Myeloma Working Group criteria. The primary endpoint was overall response rate (ORR). Secondary endpoints included overall survival (OS), progression-free survival (PFS), and duration of response (DOR). We identified 27 patients who received BP for quad- or penta-refractory MM. The median number of prior lines of therapy was 6. The ORR for BP was 26%. The median PFS for BP was 1.4 months (95% CI 1.1-1.6) and median OS was 8.7 months (95% CI 2.3-15.0). Patients treated with cyclophosphamide had less response to BP. Thirty-one patients received DCEP for quad-refractory or penta-refractory MM. The median number of prior treatment regimens was 8. The ORR to DCEP was 35%. The median PFS was 2.7 months (95% CI 1.5-3.8) and median OS was 6.2 months (95% CI 4.4-7.8). DCEP and BP retain efficacy in quad- and penta-refractory MM. Our analysis supports prospective study of these regimens, possibly in combination or in comparison with other agents in this area of unmet need.
多发性骨髓瘤（MM）几乎总是通过新的治疗方法进展。四药难治性 MM（对硼替佐米、卡非佐米、来那度胺和泊马度胺耐药）和五药难治性 MM（对达雷妥尤单抗另外耐药）的治疗选择有限。两种化疗方案，苯达莫司汀/泼尼松（BP）和地塞米松、环磷酰胺、依托泊苷和顺铂（DCEP），常用于四药和五药难治性 MM，但在这种预处理人群中，关于结局的数据有限。我们进行了一项单中心回顾性研究，以确定所有接受 DCEP 和/或 BP 治疗四药或五药难治性 MM 的患者。疾病反应和耐药性通过国际骨髓瘤工作组标准定义。主要终点是总缓解率（ORR）。次要终点包括总生存期（OS）、无进展生存期（PFS）和缓解持续时间（DOR）。我们确定了 27 例接受 BP 治疗四药或五药难治性 MM 的患者。先前治疗线数的中位数为 6。BP 的 ORR 为 26%。BP 的中位 PFS 为 1.4 个月（95%CI 1.1-1.6），中位 OS 为 8.7 个月（95%CI 2.3-15.0）。接受环磷酰胺治疗的患者对 BP 的反应较小。31 例患者接受 DCEP 治疗四药难治性或五药难治性 MM。先前治疗方案的中位数为 8。DCEP 的 ORR 为 35%。中位 PFS 为 2.7 个月（95%CI 1.5-3.8），中位 OS 为 6.2 个月（95%CI 4.4-7.8）。DCEP 和 BP 在四药和五药难治性 MM 中仍具有疗效。我们的分析支持对这些方案进行前瞻性研究，可能是联合或与该领域未满足需求的其他药物进行比较。
