A single-day polychemotherapy regimen with proteasome inhibitor combinations for relapsed/refractory myeloma in the era of novel therapies

IF 2.3 3区 医学 Q2 HEMATOLOGY European Journal of Haematology Pub Date : 2024-07-02 DOI:10.1111/ejh.14266
Eric Wenlong Li, Esther Jones, Christian Bryant, Tracy King, Dipti Talaulikar, Jun Yen Ng, Adam Bryant, Zainab Ridha, Nicole Wong Doo, Anna Menzies, Silvia Ling, Shir Jing Ho, Edward Abadir, Vinay Vanguru, Douglas Joshua, P. Joy Ho
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Abstract

PCAB (prednisone, cyclophosphamide, doxorubicin, carmustine) is a single-day regimen previously used for induction and now in relapsed/refractory multiple myeloma (RRMM). We retrospectively analysed the outcomes of 85 patients from five Australian centres. These included 30 patients (35.3%) who received PCAB with one additional agent (bortezomib most frequently). Median age of the patients was 65 years (37–80), with a median of four (1–8) prior lines of therapy. ORR was 37% (CR 4.9%). Median progression free survival and overall survival were 4.4 months (95% CI 3.5–6.7) and 7.4 months (95% CI 6.4–10.2), respectively. Extramedullary disease (EMD) was associated with shorter survival. Grade 3 or 4 cytopenia and febrile neutropenia occurred in 76.2% and 39.1%, respectively, with six (7.1%) treatment-related mortalities. Median inpatient stay was 3.3 days/28-day cycle (IQR 0.6–13), and for patients who died, a median of 20.2% of days alive were spent inpatient (IQR 6.4–39.1%). Three patients were successfully bridged to CAR T-cell therapy using PCAB, despite being penta-exposed and having EMD. PCAB may be considered as a useful salvage therapy amongst other polychemotherapy regimens in late relapse. Further studies is warranted to investigate and define its role as a bridging therapy to novel therapeutics.

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新疗法时代,蛋白酶体抑制剂联合治疗复发/难治性骨髓瘤的单日多化疗方案。
PCAB(泼尼松、环磷酰胺、多柔比星、卡莫司汀)是一种单日疗法,以前用于诱导治疗,现在用于复发/难治性多发性骨髓瘤(RRMM)。我们回顾性分析了来自澳大利亚五个中心的 85 名患者的治疗结果。其中有 30 名患者(35.3%)在接受 PCAB 治疗的同时还使用了一种额外的药物(最常用的是硼替佐米)。患者的中位年龄为 65 岁(37-80 岁),中位曾接受过四次(1-8 次)治疗。ORR为37%(CR为4.9%)。中位无进展生存期和总生存期分别为4.4个月(95% CI 3.5-6.7)和7.4个月(95% CI 6.4-10.2)。髓外疾病(EMD)与生存期缩短有关。3级或4级全血细胞减少症和发热性中性粒细胞减少症的发生率分别为76.2%和39.1%,治疗相关死亡率为6例(7.1%)。住院天数中位数为 3.3 天/28 天周期(IQR 0.6-13),死亡患者的住院天数中位数为 20.2%(IQR 6.4-39.1%)。有三位患者使用PCAB成功过渡到了CAR T细胞疗法,尽管他们已经暴露于五联征并患有EMD。在晚期复发的患者中,PCAB可被视为其他多化疗方案中一种有用的挽救疗法。我们有必要开展进一步的研究,探讨并确定PCAB作为新型疗法的桥接疗法的作用。
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来源期刊
CiteScore
5.50
自引率
0.00%
发文量
168
审稿时长
4-8 weeks
期刊介绍: European Journal of Haematology is an international journal for communication of basic and clinical research in haematology. The journal welcomes manuscripts on molecular, cellular and clinical research on diseases of the blood, vascular and lymphatic tissue, and on basic molecular and cellular research related to normal development and function of the blood, vascular and lymphatic tissue. The journal also welcomes reviews on clinical haematology and basic research, case reports, and clinical pictures.
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