Pomalidomide and Dexamethasone Are Effective in Relapsed or Refractory Multiple Myeloma in a Real-Life Setting: A Multicenter Retrospective Study in Taiwan.

Yu-Chin Hung,Bor-Sheng Ko,Jyh-Pyng Gau,Shang-Yi Huang,Chieh-Lin Jerry Teng

doi:10.3389/fonc.2021.695410

Abstract

BackgroundThe therapeutic options of relapsed or refractory multiple myeloma (RRMM) remain a challenge. The MM-003 trial demonstrated that RRMM patients treated with pomalidomide and dexamethasone (Pom/Dex) have better progression-free survival (PFS) than those treated with high-dose dexamethasone alone. However, the real-world effectiveness of Pom/Dex in these patients in Taiwan remains unclear.MethodsThis multicenter, registry-based study retrospectively reviewed the medical records of 49 consecutive patients undergoing Pom/Dex treatment for RRMM. We investigated the overall response rate (ORR) and PFS in these patients. The patients were stratified into two groups: those who received two (n=33) and those who received more than two (n=16) prior lines of treatment according to the numbers of regimens before Pom/Dex therapy. The differences in ORR and PFS between these two groups were further analyzed. We also analyzed factors attributed to disease progression.ResultsThe ORR was 47.7%, and the median PFS was 4.0 months (range, 0.1−21.1). Patients who received two prior lines of treatment had a higher ORR than those who received more than two prior lines of treatment (55.2% vs. 33.3%; p=0.045). The median PFS of these groups was 4.8 and 3.9 months, respectively (p=0.805). Primary lenalidomide refractoriness reduced the risk of myeloma progression following Pom/Dex treatment (hazard ratio, 0.14; p=0.001).ConclusionsThe median PFS following Pom/Dex treatment in Taiwanese RRMM patients in a real-world setting was similar to that reported by the MM-003 trial. Primary lenalidomide refractoriness should not be an obstacle for Pom/Dex treatment in RRMM.

Highlights

Multiple myeloma (MM) is a hematologic malignancy that clinically presents with anemia, bone pain, impaired renal function, and hypercalcemia
Patients who received two prior lines of treatment were younger (63.0 vs. 71.0 years; p = 0.007) and had a higher percentage of primary lenalidomide refractoriness (42.4% vs. 0%; p = 0.002) than those who received more than two prior lines of treatment (Table 1)
The median progression-free survival (PFS) in patients who received two and those who received more than two prior lines of treatment were 4.8 and 3.9 months, respectively

Summary

Introduction

Multiple myeloma (MM) is a hematologic malignancy that clinically presents with anemia, bone pain, impaired renal function, and hypercalcemia. MM remains an incurable disease, the treatment outcome of MM has significantly improved over the past decade One reason for such improvement is the induction treatment with bortezomib. In the VISTA trial, transplantineligible newly diagnosed MM patients undergoing induction therapy of bortezomib plus melphalan and prednisone were found to have better progression-free survival (PFS) and overall survival (OS) than those treated with melphalan and prednisolone (2). Both bortezomib-thalidomidedexamethasone and bortezomib-cyclophosphamidedexamethasone inductions provide a response rate of as high as 80% to transplant eligible newly diagnosed MM patients (3). The real-world effectiveness of Pom/Dex in these patients in Taiwan remains unclear

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Conclusion