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DCEP and bendamustine/prednisone as salvage therapy for quad- and penta-refractory multiple myeloma

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Abstract

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.

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Acknowledgments

SG wishes to acknowledge the Washington University School of Medicine R25 STRENGTH Program (R25CA190190; PI Ramaswamy Govindan, MD) for protected research time.

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This study received a formal Waiver of Informed Consent from the Institutional Review Board at Washington University School of Medicine due to the retrospective nature, lack of active intervention, deidentified data, and assessed minimal risk to the subjects.

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Goldsmith, S.R., Fiala, M.A., Wang, B. et al. DCEP and bendamustine/prednisone as salvage therapy for quad- and penta-refractory multiple myeloma. Ann Hematol 99, 1041–1048 (2020). https://doi.org/10.1007/s00277-020-03970-2

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