Abstract
Objective:Multiple myeloma patients who are relapsed or refractory to both proteasome inhibitors (PIs) and immunomodulatory drugs (IMiDs) have been reported to have poor outcomes. Bendamustine has been reported to have an antitumor effect in newly diagnosed as well as relapsed/refractory multiple myeloma (RRMM). The aim of this retrospective study was to evaluate the efficacy of bendamustine therapy in heavily pretreated MM patients who were refractory to PIs and IMiDs.Materials and Methods:Nineteen RRMM patients treated either with bendamustine and steroids (n=13) or a combination of bendamustine with novel drugs (n=6) were included. The median number of previous treatment lines was 5 (minimum-maximum: 3-8) and median time from diagnosis was 6 years (minimum-maximum: 1-16). All of the patients were resistant to at least one of the IMiDs and one of the PIs. Bendamustine was given at doses ranging from 90 mg/m2 to 120 mg/m2 on days 1 and 2 of 28-day cycles.Results:A median of 2 (minimum-maximum: 1-8) treatment cycles was administered per patient. The toxicity of bendamustine was mild and mostly of hematological origin. No complete remission was achieved. There was partial remission and stable disease in 21% and 11% of the patients, respectively. Sixty-eight percent of patients had progressive disease. The median progression-free survival and overall survival was 2 and 4 months, respectively.Conclusion:Bendamustine therapy was well tolerated but showed limited anti-myeloma activity in heavily pretreated patients who were refractory to IMiDs and PIs.
Highlights
Multiple myeloma (MM) is the second most common hematological malignancy, accounting for an estimated 1% of all cancers [1]
Bendamustine therapy was well tolerated but showed limited anti-myeloma activity in heavily pretreated patients who were refractory to IMiDs and proteasome inhibitors (PIs)
We think that the main contribution of our study to the current literature is showing the efficacy of bendamustine in heavily pretreated MM patients who were refractory to both IMiDs and PIs
Summary
Multiple myeloma (MM) is the second most common hematological malignancy, accounting for an estimated 1% of all cancers [1]. Introduction of high-dose chemotherapy followed by stem cell rescue and novel treatment modalities such as immunomodulatory drug (IMiD) agents and proteasome inhibitors (PIs) over the past 20 years have led to improved survival rates in patients with MM [2,3]. The United States Food and Drug Administration approved two monoclonal antibodies indicated for the treatment of MM, which will further help improve the response and survival rates in relapsed refractory multiple myeloma (RRMM). Despite advances in its treatment, MM is still considered to be an incurable disease. For patients who relapse after treatment with novel agents therapeutic strategies are inadequate and usually result in a dismal prognosis. While some salvage treatments exist, patients may not respond to them or may be unable to tolerate them due to toxicities
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