title: Bendamustine in combination with thalidomide and dexamethasone is a viable salvage option in myeloma relapsed and/or refractory to bortezomib and lenalidomide.
abstract: Treatment options are limited in myeloma relapsed or refractory to both bortezomib and lenalidomide (double-relapsed/refractory multiple myeloma; DRMM). Bendamustine is an antitumour agent that has efficacy in relapsed myeloma. We retrospectively analysed data from 30 DRMM patients who received a combination of bendamustine, thalidomide and dexamethasone (BTD) in 28-day treatment cycles. Bendamustine was administered with a cumulative dose of up to 200 mg/m(2). Thalidomide (50-150 mg) was given daily as tolerated, and dexamethasone was given at an equivalent dose of up to 160 mg per cycle. A median of 5 (2-9) treatment cycles were administered per patient. Twenty-six patients (87 %) achieved stable disease or better. At a median follow-up time of 12.1 (2.3-21.5) months, median (95 % CI) progression-free survival and overall survival were 4.0 (2.6-5.3) months and 7.2 (5.2-9.2) months, respectively. The most common grade 3-4 adverse events were haematological: anaemia (n = 8, 34.8 %), neutropenia (n = 16, 69.6 %) and thrombocytopenia (n = 10, 43.5 %). Non-haematological toxicities included pain (n = 3, 13.0 %), infection (n = 7, 30.4 %) and sensory neuropathy (n = 1, 4.3 %). We propose that BTD is a viable salvage treatment option for DRMM patients.
authors.affiliation: Level 2, Cancer and Hematology Centre, Churchill Hospital, Oxford University Hospitals NHS Trust, Oxford, OX3 7LE, UK, ijunlau@doctors.org.uk.
authors.forename: I-Jun
authors.initials: IJ
authors.lastname: Lau
authors.forename: Dean
authors.initials: D
authors.lastname: Smith
authors.forename: Robin
authors.initials: R
authors.lastname: Aitchison
authors.forename: Norbert
authors.initials: N
authors.lastname: Blesing
authors.forename: Pamela
authors.initials: P
authors.lastname: Roberts
authors.forename: Andrew
authors.initials: A
authors.lastname: Peniket
authors.forename: Kwee
authors.initials: K
authors.lastname: Yong
authors.forename: Neil
authors.initials: N
authors.lastname: Rabin
authors.forename: Karthik
authors.initials: K
authors.lastname: Ramasamy
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D000069461:Bendamustine Hydrochloride; D001897:Boronic Acids / Q000627:therapeutic use*; D000069286:Bortezomib; D003907:Dexamethasone / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D000077269:Lenalidomide; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000188:drug therapy* / Q000401:mortality; D009588:Nitrogen Mustard Compounds / Q000008:administration & dosage*; D011719:Pyrazines / Q000627:therapeutic use*; D012008:Recurrence; D012189:Retrospective Studies; D016879:Salvage Therapy / Q000379:methods*; D016019:Survival Analysis; D013792:Thalidomide / Q000008:administration & dosage* / Q000031:analogs & derivatives* / Q000627:therapeutic use; D017211:Treatment Failure
chemical_list: D001897:Boronic Acids; D009588:Nitrogen Mustard Compounds; D011719:Pyrazines; D013792:Thalidomide; D000069286:Bortezomib; D003907:Dexamethasone; D000069461:Bendamustine Hydrochloride; D000077269:Lenalidomide