The lymphoma-like polychemotherapy regimen “Dexa-BEAM” in advanced and extramedullary multiple myeloma

Abstract

Extramedullary disease (EMD) in multiple myeloma (MM) is characterised by an aggressive biology and an adverse prognosis especially when occurring at relapse. Due to the high proliferation found in EMD lesions, we analysed outcome data of patients treated with a lymphoma-type therapy not based on novel compounds, the Dexa-BEAM protocol. Retrospective analysis of MM patients having received Dexa-BEAM (including dexamethasone, carmustine, cytarabine, etoposide and melphalan) at our institution from January 2007 to November 2012. In all, 18 patients were identified, 11 of whom had EMD. Objective response (≥PR) to Dexa-BEAM was achieved in more than half of the patients with EMD (6/11); consecutive high-dose consolidation strategy with autologous or allogeneic stem cell transplantation improved upon the depth of remission in two thirds of EMD patients (4/6) with ongoing remissions in three patients. In contrast, all patients without consolidation relapsed. Progression-free survival after Dexa-BEAM was short in both patient groups with intramedullary or extramedullary myeloma with a median of 3 and 4 months, respectively. Toxicity was relevant with one treatment-related death and grades 3 and 4 toxicities in all 18 patients. Dexa-BEAM is an effective induction regimen in medically fit patients with extramedullary manifestations to regain disease control prior to an intended autologous or allogeneic transplantation.

CXCR4-directed endoradiotherapy induces high response rates in extramedullary relapsed Multiple Myeloma

“…In these patients of highest risk, despite most intense treatments applied, response rates are being described as consistently poor (ranging from 24-54%) and overall survival times are disappointingly short (4-7 months) 3, 22, 23. Similarly in our cohort, time to disease relapse was relatively short in all studied patients with median progression-free and overall survival times of 54 and 223 days, respectively.…”

Carfilzomib Based Treatment Strategies in the Management of Relapsed/Refractory Multiple Myeloma with Extramedullary Disease

“…In a previous study of our institution investigating patients with EMD prior to the carfilzomib era, patients were treated with intensive chemotherapy, such as VDT-PACE, VRD-ICE, RAD, VCDT, and autologous or allogeneic SCT, and we observed a median PFS and OS of two (95% CI, 0.08-3.92) and seven (95% CI, 3.56-10.43) months, respectively [11]. Additionally, Rasche et al reported a median PFS of four months in patients with extramedullary RRMM treated with DexaBEAM [17]. At our institution, the novel CXCR4-directed endoradiotherapy (ERT) has shown promising efficacy (ORR 75%) but no favorable survival outcome (median PFS 54 days, range 13-175 days and median OS 223 days, range 13-313 days) in extramedullary relapsed MM [42].…”

How we manage autologous stem cell transplantation for patients with multiple myeloma

“…96 Evidence suggests that dexamethasone with carmustine, etoposide, cytarabine, and melphalan is an effective conditioning regimen, particularly in patients with extramedullary disease. 97 Bortezomib has been added to carmustine, etoposide, cytarabine, and melphalan in the setting of salvage transplantation and resulted in a 20% therapy-related mortality rate. 98 Melphalan remains the standard for transplantation, but the addition of novel agents to conditioning is being actively explored.…”