Abstract
Novel agents such as thalidomide, lenalidomide, and bortezomib have been shown to possess potent activity against multiple myeloma. However, the treatment strategy for patients who acquired resistance to these agents has not been established. In addition to switching drug classes, intensified treatment strategy, including increase in the dosage of current agents and addition of other agents, may be considered for these patients. We here describe 2 myeloma patients with acquired resistance to bortezomib or lenalidomide, in whom add-on therapy with low-dose cyclophosphamide was effective and tolerable. These cases suggest that add-on therapy with cyclophosphamide is one of the treatment options to overcome resistance to novel agents in patients with multiple myeloma. A larger prospective study is needed to clarify the efficacy and safety of this strategy for novel agent-resistant multiple myeloma.
Highlights
Introduction of immunomodulatory drugs (IMiDs), such as thalidomide and lenalidomide, and the proteasome inhibitor bortezomib has dramatically improved outcomes in patients with multiple myeloma (MM) [1,2,3,4]
We presented here that add-on therapy with CY was effective and tolerable in patients with MM who developed resistance to lenalidomide or bortezomib
The patient was considered to have lenalidomide-refractory MM. van de Donk et al reported the efficacy of combination regimen with lenalidomide, CY, and PSL for patients with RRMM, including lenalidomiderefractory patients [16]
Summary
Novel agents such as thalidomide, lenalidomide, and bortezomib have been shown to possess potent activity against multiple myeloma. The treatment strategy for patients who acquired resistance to these agents has not been established. We here describe 2 myeloma patients with acquired resistance to bortezomib or lenalidomide, in whom add-on therapy with low-dose cyclophosphamide was effective and tolerable. These cases suggest that addon therapy with cyclophosphamide is one of the treatment options to overcome resistance to novel agents in patients with multiple myeloma. A larger prospective study is needed to clarify the efficacy and safety of this strategy for novel agent-resistant multiple myeloma
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