Pomalidomide in Combination with Low-Dose Dexamethasone as the Treatment of “Double Refractory” Multiple Myeloma

LYMPHOID TUMORS , , ,

AV Petrov2, DV Motorin2, OS Pokrovskaya1, ES Urnova1, MV Nareiko1, DV Babenetskaya2, YuA Alekseeva2, LL Girshova2, LP Mendeleeva1, AYu Zaritskii2

1 Hematology Research Center, 4а Novyi Zykovskii pr-d, Moscow, Russian Federation, 125167

2 Federal Almazov North-West Medical Research Centre, 2 Akkuratova str., Saint Petersburg, Russian Federation, 197341

For correspondence: Aleksei Vladilenovich Petrov, 2 Akkuratova str., Saint Petersburg, Russian Federation, 197341; Tel.:+7(921)317-28-02; e-mail: avlpetrov@mail.ru

For citation: Petrov AV, Motorin DV, Pokrovskaya OS, et al. Pomalidomide in Combination with Low-Dose Dexamethasone as the Treatment of “Double Refractory” Multiple Myeloma. Clinical oncohematology. 2017;10(3):372–80 (In Russ).

DOI: 10.21320/2500-2139-2017-10-3-372-380

ABSTRACT

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.

Keywords: multiple myeloma, “double-refractoriness”, immunomodulating agents, pomalidomide.

Received: January 24, 2017

Accepted: May 6, 2017

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