Multiple myeloma (MM) is a neoplastic plasma cell disorder characterized by clonal proliferation of malignant plasma cells in bone marrow and has a high risk for relapse. With more targeted agents in development, the treatment of myeloma patient at relapse has become complicated. Carfilzomib and pomalidomide are new agents for double-refractory MM.
We aimed to evaluate efficacy and hematological adverse effects of carfilzomib and pomalidomide on relapse and refractory MM (RR-MM) patients.
Fourty RR-MM patients who treated with carfilzomib or pomalidomide between 2016 and 2018 in Ege University, School of Medicine were screened, retrospectively. Patients seperated into three groups who were treated with carfilzomib (n=25), pomalidomide (n=8) or both of two drugs, consecutively (n=7). Complete blood counts, renal functional tests, serum immunoglobuline heavy and light chain levels, bone marrow aspiration and biopsies, bone lesions, ISS scores at diagnosis, follow up periods, performance status (according to ECOG performance scale), response status to treatment and hematological adverse effects are evaluated.
Fourty RR-MM patients were evaluated. The median age was 65 (range 45-85) and the median age at diagnosis was 60 (range 42-80). Mean follow-up period was 71 months (range 13-200). The patients were composed of 19 ( 47.5%) females and 21 (52.5%) males. ECOG performance status of 30 patients were 0, 16 patients were 1, and 2 patients were 2. ISS scores of 16 patients were 1, 13 patients were 2 and 7 patients were 7. Patients had received 4 lines of therapy prior to carfilzomib and the mean number of carfilzomib administration cycle was 6 (range 2-15). Before pomalidomide treatment patients had received 4 lines therapy and the mean number of pomalidomide treatment was 12 (range 2-32). Six patients’s treatment was changed from pomalidomide to carfilzomib by the reason of disease progression or intolerance, while one patient’s treatment was changed carfilzomib to pomalidomide. Six patients died; four of them were under carfilzomib treatment, two of them were treated with pomalidomide. 13 (40.6%) of 32 patients who were treated with carfilzomib had disease progression or had not continued to therapy because of intolerance. Until disease progression, patients were received 4 cycles therapy. At pomalidomide group, 2 of 15 patients had intolerance to therapy and 2 patients were died because of pulmonary infection. 7 patiens had disease progression and patients had taken in average 13.2 cycles therapy until disease progression. The most common hematological adverse effect was thrombocytopenia in both groups. 10 patients (31.2%) in carfilzomib group and 5 patients (33.3%) in pomalidomide group had thrombocytopenia.
Despite of the current report has limitations and small numbers of patients, our results has revealed that carfilzomib and pomalidomide have durable efficacy and well-tolerated agents for relaps refractory myleoma and the most common hematological adverse effect was thrombocytopenia as also stated in the literature.
Session topic: 14. Myeloma and other monoclonal gammopathies - Clinical
Keyword(s): Multiple myeloma