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DCEP and bendamustine/prednisone as salvage therapy for quad- and penta-refractory multiple myeloma.
Annals of Hematology ( IF 3.5 ) Pub Date : 2020-03-04 , DOI: 10.1007/s00277-020-03970-2
Scott R Goldsmith 1 , Mark A Fiala 1 , Brandon Wang 1 , Mark A Schroeder 1 , Tanya M Wildes 1 , Armin Ghobadi 1 , Keith Stockerl-Goldstein 1 , Ravi Vij 1
Affiliation  

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.

中文翻译:

DCEP和苯达莫司汀/泼尼松作为四线和五线难治性多发性骨髓瘤的挽救疗法。

多发性骨髓瘤(MM)几乎总是通过新疗法发展。四难治性MM(对硼替佐米,卡非佐米,来那度胺和泊马利度胺难治)和五难治疗的MM(对达拉他单抗附加难治性)的患者几乎没有治疗选择。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)这两种化疗方案通常用于四点和五点难治性MM,但在这一高度预处理的人群中,关于结局的数据有限。我们进行了一项单中心回顾性研究,以鉴定所有接受DCEP和/或BP治疗的四难或五难MM患者。通过国际骨髓瘤工作组标准定义疾病反应和难治性。主要终点是总体缓解率(ORR)。次要终点包括总体生存期(OS),无进展生存期(PFS)和反应持续时间(DOR)。我们确定了27例因四重或五重难治性MM接受BP治疗的患者。先前治疗的中位数为6。BP的ORR为26%。BP的中位数PFS为1.4个月(95%CI 1.1-1.6),OS的中位数为8.7个月(95%CI 2.3-15.0)。用环磷酰胺治疗的患者对血压的反应较小。31例接受四难或五难MM的DCEP患者。先前治疗方案的中位数为8。DCEP的ORR为35%。PFS中位数为2.7个月(95%CI 1.5-3.8),OS中间值为6.2个月(95%CI 4.4-7.8)。DCEP和BP在四点和五点难治性MM中保持疗效。我们的分析支持对这些方案的前瞻性研究,
更新日期:2020-03-04
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