Carfilzomib Lenalidomide Dexamethasone In The Management Of Lenalidomide Refractory Multiple Myeloma

Author : Cerchione Claudio
Publisher :
ISBN 13 :
Total Pages : pages
Book Rating : 4.:/5 (125 download)

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Download or read book Carfilzomib-Lenalidomide-Dexamethasone In The Management Of Lenalidomide-Refractory Multiple Myeloma written by Cerchione Claudio and published by . This book was released on 2017 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt: Title: CARFILZOMIB-LENALIDOMIDE-DEXAMETHASONE IN THE MANAGEMENT OF LENALIDOMIDE-REFRACTORY MULTIPLE MYELOMAAuthors: C. Cerchione, K. Ferrara, I. Peluso, M. Di Perna, I. Zacheo, D. Nappi, A. E. Pareto, F. Pane, L. CatalanoCONTEXT: Carfilzomib-Lenalidomide-Dexamethasone is effective in heavily pretreated Multiple Myeloma, refractory to lenalidomideOBJECTIVE: Carfilzomib is an epoxyketone proteasome inhibitor of second generation, proved to be effective and safe in relapsed and refractory Multiple Myeloma (rrMM), in combination with dexamethasone or lenalidomide and dexamethasone.DESIGN: In this retrospective observational trial, it has been evaluated efficacy and safety of carfilzomib, in combination with lenalidomide-dexamethasone (KRD) as salvage regimen in patients with rrMM, refractory to lenalidomide, whose prognosis is particularly severe.SETTING : Relapsed and Refractory Multiple MyelomaPATIENTS OR OTHER PARTICIPANTS: 31 patients (19 M/12 F), with rrMM, median age at diagnosis 64 years (r. 47-82), median age at start of treatment 68 years (r. 48-84) previously treated with several lines of treatments (median 3, r. 2-11), underwent to KRD regimen (ASPIRE trial schedule) for a median treatment cycles of 4 (r 1-14).ISS was equally distributed, and cytogenetic was evaluable in 8 patients, and in particular one del13q14 1q gain, one del13q14 and one t(11;14). All patients had previously been treated with bortezomib and IMIDs, and were refractory to this agents. 61% (19/31) of them had undergone at least to a single autologous SCT.RESULTS: According to IMWG criteria, after a median follow-up of 3 months (r.1-13), ORR was 67,7% (21/31: 5 CR, 9 VGPR, 7 PR) with 4 progressive diseases (PD) and 6 patients in stable disease (SD): this can be considered as an impressive result in this subset of rrMM patients, refractory to lenalidomide. In particular, for 2 patients, KRD was, after having achieved at least a PR, a bridge to second autologous SCT.Median time to response was 2 months (r.1-4), median OS from diagnosis was 57 months (r. 9-170), median OS from start of Carfilzomib was 6 months (r. 1-14).Carfilzomib was well tolerated, with grade 2 anemia in 35% (11/31) of patients, successfully managed by ESAs, without necessity of blood transfusions; 19% (6/31) grade 3-4 neutropenia (pegfilgrastim in primary prophylaxis was given, no ospedalization was required, no septic shocks were observed); 32% (10/31) grade 2, 19% (6/31) grade 3 and 9% (3/31) grade 4 thrombocytopenia, without hemorrhagic events and necessity of transfusions. Concerning severe extra-hematologic toxicity, it was observed pneumonia in 45% (14/31) of patients, treated by common antibiotic drugs; hypertension (grade 2-3) in 35% (11/31) of patients; arrhythmias in 9% (3/31) of patients; dyspnea in 16% (5/31) of patients; fatigue in 32% (10/31) of patients. All patients were carefully monitored by expert cardiologists of our deparment.CONCLUSIONS: Carfilzomib-Lenalidomide-Dexamethasone has shown significant efficacy in a particularly severe setting of patients, relapsed and refractory to all available therapeutic resources, also lenalidomide, and, in particular cases, it could be considered as a bridge to a second autologous or allogenic SCT.