Case Report: Pomalidomide as Consolidation Therapy after Salvage Autologous Stem Cell Transplant

Abstract

Over the past decade there have been many advances in the treatment of multiple myeloma (MM). In the first-line setting, induction treatment followed by high-dose chemotherapy plus autologous stem cell transplant (ASCT) is still considered the standard of care for eligible patients. Maintenance therapy has become a mainstay in MM treatment for both transplant-eligible and eineligible patients and, accordingly, a recent study showed that in both groups maintenance treatment with the immunomodulatory drug (IMiD) lenalidomide led to an improved progression-free survival (1). The vast majority of MM patients will eventually suffer a relapse or progression of their disease. Novel therapies such as pomalidomide(POM), a next-generation IMiD approved for patients with relapsed / refractory myeloma (RRM), and carfilzomib have expanded treatment options and increased progression-free survival. Despite the role of new therapies, salvage ASCT remains an effective and useful tool for many patients. Reinduction therapy followed by salvage ASCT should be considered in patients who have responded well to their initial transplant and have had a progression-free interval of at least 12-18 months (2). It is an open question, however, whether patients will derive a similar benefit from consolidation/maintenance (CM) treatment after salvage ASCT as they do in the first-line setting. In this report, we describe the clinical course of 4 consecutive patients who received CM treatment with POM after salvage therapy with high-dose melphalan (HDM) followed by ASCT. Since POM has received FDA-approval for the treatment of patients with RRM, we have placed 4 patients on CM treatment with POM following