Cyclophosphamide etoposide dexamethasone as salvage and bridging therapy in relapsed refractory and extramedullary multiple myeloma.
Joseph KauerLilli Sophie SesterKatharina KriegsmannNiels WeinholdMichael OberCarsten Müller-TidowHartmut GoldschmidtMarc-Steffen RaabSandra SauerPublished in: Hematological oncology (2023)
Patients with relapsed refractory multiple myeloma (RRMM) that are triple-exposed to immunomodulatory drugs, proteasome inhibitors, and anti-CD38 monoclonal antibodies have a poor prognosis. Standard treatment for these patients has not been established. Patients with extramedullary disease or secondary plasma cell leukemia often display high tumor cell proliferation and might therefore be susceptible to chemotherapy. While current regimens are often platinum-based, we present single-center data on 70 patients with RRMM who were treated with cyclophosphamide, etoposide, and dexamethasone (CED) after a median of four lines of therapy. An overall response rate of 52% was achieved after 1-6 cycles, with 23% of patients having a very good partial response. Comparable response rates and survival were observed in patients with extramedullary disease and high-risk cytogenetics. Treatment resulted in non-hematological °III-IV adverse events in 31% of patients. No treatment-related deaths occurred. The median progression-free and overall survival were 6.2 and 10.9 months, respectively. 23% of patients were bridged to autologous stem cell transplantation (ASCT) or chimeric antigen receptor (CAR) T cell therapy. In summary, CED is an effective treatment regimen for RRMM cases with a tolerable safety profile and suitable as bridging therapy to CAR T cell treatment and ASCT.
Keyphrases
- end stage renal disease
- cell therapy
- multiple myeloma
- poor prognosis
- ejection fraction
- newly diagnosed
- chronic kidney disease
- high dose
- stem cell transplantation
- cell proliferation
- low dose
- prognostic factors
- acute myeloid leukemia
- stem cells
- peritoneal dialysis
- acute lymphoblastic leukemia
- bone marrow
- squamous cell carcinoma
- artificial intelligence
- mesenchymal stem cells
- replacement therapy
- electronic health record
- diffuse large b cell lymphoma
- big data
- smoking cessation
- platelet rich plasma
- locally advanced