Use of KRD-PACE as Salvage Therapy in Aggressive, Relapsed/Bortezomib-Refractory Extramedullary Multiple Myeloma: A Report of Two Cases and Literature Review

Abstract

Extramedullary multiple myeloma is defined by the presence of plasma cell infiltration outside of the bone marrow. It is associated with a poor prognosis and resistance to therapy and is often associated with high-risk cytogenetics. Aggressive relapsed and refractory extramedullary multiple myeloma is often treated with salvage infusional chemotherapy to achieve rapid disease control. Commonly used regimens include DCEP, CVAD, and VTD-PACE. While VTD-PACE contains bortezomib and thalidomide which have potent antimyeloma activity, the advent of novel agent therapy with proteasome inhibitors and immunomodulatory agents being used in the first-line setting has resulted in many patients being refractory to bortezomib by the time they are treated with VTD-PACE. Herein, we discuss two cases of aggressive relapsed, high-risk, bortezomib-refractory extramedullary multiple myeloma treated with KRD-PACE and review the available clinical data on salvage chemotherapy regimens used in relapsed refractory myeloma.

Outcomes of VDPACE with an immunomodulatory agent as a salvage therapy in relapsed/refractory multiple myeloma with extramedullary disease

“…Even in patients with triple refractory disease, the VDPACE +IMiD–based regimen maintained its efficacy. The VDPACE +IMiD regimen performed in EMD similarly to previously published experience in RRMM disease without EMD, with results also similar to other multichemotherapy regimens like DCEP (dexamethasone, cyclophosphamide, etoposide, and cisplatin) [ 29 , 30 , 31 , 32 , 33 ].…”

Risk and Response-Adapted Treatment in Multiple Myeloma

“…A lack of protocol inclusion is a reason for the lack of information about the best treatment choice and, just recently, two prospective trials have demonstrated the feasibility of the inclusion of bortezomib (V)-based and lenalidomide (R)-based regimens [13,14]. In young patients, the combination of bortezomib or thalidomide (T) with high-dose chemotherapy as hyper-CVAD-VD or VTD/VRD/KRD-PACE, may be envisaged [15]. Given that autologous stem cell transplantation (ASCT) is the most appropriate therapeutic choice for eligible patients, the role of tandem ASCT or alloSCT is still debated [16].…”

Clinical case of giant extramedullar plasmacytoma in a patient with multiple myeloma

“…В настоящее время активно проводятся исследо вания в области изучения патогенеза экстрамедулляр ной плазмоцитомы при ММ [2,4]. По данным лите ратуры, наличие экстрамедуллярной плазмоцитомы является неблагоприятным фактором, характеризу ющимся агрессивным течением заболевания, отсутст вием противоопухолевого ответа на проводимую стан дартную терапию и низкими показателями общей выживаемости [5,6]. Однако благодаря полихимиоте рапии с использованием современных таргетных пре паратов и трансплантации гемопоэтических стволовых клеток (ТГСК) можно добиться длительной ремиссии и увеличения продолжительности жизни пациентов [1,4].…”