Pomalidomide, bortezomib, and dexamethasone for patients with relapsed lenalidomide-refractory multiple myeloma

Abstract

Key Points• PVD is an active combination in relapsed lenalidomiderefractory MM patients.• PVD with weekly bortezomib offers a simpler, more convenient, and well-tolerated regimen option. ; and partial response, 36%) and 100% among high-risk patients. Within a median follow-up of 42 months, 20% remain progression free, 66% are alive, and 4% remain on treatment. Median progression-free survival was 13.7 months (95% CI, 9.6-17.7). The most common toxicities were neutropenia (96%), leukopenia (84%), thrombocytopenia (82%), anemia (74%), and fatigue (72%); however, the majority of these were grade 1 or 2. The most common grade ‡3 toxicities included neutropenia (70%), leukopenia (36%), and lymphopenia (20%). Deep vein thrombosis occurred in 5 patients. In conclusion, PVD is a highly effective combination in lenalidomide-refractory MM patients. Weekly administration of bortezomib enhanced tolerability and convenience. Toxicities are manageable, mostly consisting of mild cytopenias with no significant neuropathy.

Multiple Myeloma and Thrombosis: Prophylaxis and Risk Prediction Tools

“…Body mass index >25, Age >75, Personal or family history of VTE, Central venous catheter, Acute infection or Hospitalization, Blood clotting disorders or Thrombophilia, Immobility with performance status of >1, Comorbidities (liver, renal impairment, chronic obstructive pulmonary disorder, diabetes mellitus, chronic inflammatory bowel disease), Race (Caucasian is a risk factor) These guidelines have been available since 2014; however, data from clinical trials demonstrate that the rates of residual VTE remain high [22][23][24]. Therefore, it is safe to conclude that the current risk stratification is suboptimal and fails to fully capture and distinguish between low, intermediate, and high-risk MM patients for VTE.…”

Venous thromboembolism in multiple myeloma – choice of prophylaxis, role of direct oral anticoagulants and special considerations

“…All patients received thromboprophylaxis with a high dose of aspirin (325 mg), therapeutic dose low molecular weight heparin (LMWH) or warfarin with a target International Normalised Ratio (INR) of 2-3 (of note, none of these thromboprophylaxis strategies would be routinely chosen in current clinical practice) (Lacy et al, 2009). A recent study of pomalidomide in combination with low-dose dexamethasone and bortezomib in 50 patients reported a higher VTE rate of 10%, despite using the high doses of thromboprophylactic agents detailed in the previous study (Paludo et al, 2017). A summary of trial data pertaining to VTE risk associated with the immunomodulatory drugs either alone, with dexamethasone, or with combination chemotherapy, is provided in Table II.…”

Standardization of sampling and sample preparation for analysis of human monocyte subsets in peripheral blood

“…• Patients experiencing a lenalidomide-resistant relapse may be treated with triple combination therapy: daratumumab, bortezomib, and dexamethasone [348]. Such patients may also respond to pomalidomide-based regimens [349,350].…”

“…As stated above, they probably also have cereblon-independent effects. These differences may explain why myeloma patients developing resistance to one IMiD may not be resistant to the antimyeloma effects of other IMiDs [349,350], and it may also explain the differences in toxicity profiles between different IMiDs [313].…”