title: Escalation therapy with bortezomib, dexamethasone and bendamustine for patients with relapsed or refractory multiple myeloma.
abstract: In order to improve remission rates without causing undue toxicity, we treated 50 patients with relapsed/refractory multiple myeloma according to an institutional sequential treatment algorithm. Bortezomib was given as monotherapy (1.3 mg/m(2) on day 1 + 4 + 8 + 11) followed by the addition of dexamethasone in a first (40 mg on day 1 + 4 + 8 + 11) and bendamustine (50 - 100 mg/m(2) on day 1 + 8) in a second escalation step for patients with less than a minor response. Bortezomib monotherapy was sufficient in 23 (46%) patients, treatment escalation with dexamethasone was necessary in 20 (40%) patients and 7 (14%) patients needed triple combination therapy. Overall response rate was 84% while toxicity was manageable. Median time to progression and overall survival were 8 and 20 months, respectively. In conclusion, this treatment algorithm resulted in responses in the majority of heavily pre-treated patients while at the same time restricting the toxicity of triple combination therapy to only 14% of non-responding patients.
authors: Department of Haematology, Oncology and Clinical Immunology, Heinrich-Heine University, Duesseldorf, Germany. fenk@med.uni-duesseldorf.de
authors: Roland
authors: R
authors: Fenk
authors: Mark
authors: M
authors: Michael
authors: Fabian
authors: F
authors: Zohren
authors: Thorsten
authors: T
authors: Graef
authors: Akos
authors: A
authors: Czibere
authors: Ingmar
authors: I
authors: Bruns
authors: Frank
authors: F
authors: Neumann
authors: Barbara
authors: B
authors: Fenk
authors: Rainer
authors: R
authors: Haas
authors: Guido
authors: G
authors: Kobbe
mesh_terms: D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D000069461:Bendamustine Hydrochloride; D001897:Boronic Acids / Q000008:administration & dosage* / Q000009:adverse effects; D000069286:Bortezomib; D003907:Dexamethasone / Q000008:administration & dosage* / Q000009:adverse effects; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000188:drug therapy* / Q000401:mortality; D009588:Nitrogen Mustard Compounds / Q000008:administration & dosage* / Q000009:adverse effects; D011719:Pyrazines / Q000008:administration & dosage* / Q000009:adverse effects; D016879:Salvage Therapy
chemical_list: D001897:Boronic Acids; D009588:Nitrogen Mustard Compounds; D011719:Pyrazines; D000069286:Bortezomib; D003907:Dexamethasone; D000069461:Bendamustine Hydrochloride