title: Long-term disease control by pomalidomide-/dexamethasone-based therapy in a patient with advanced multiple myeloma: a case report and review of the literature.
abstract: BACKGROUND
  Therapy for multiple myeloma (MM) has substantially improved in the era of immunomodulatory drugs and bortezomib. However, the prognosis of patients with progressive disease despite treatment with these 'novel agents' remains poor. Recently, pomalidomide was approved in this setting, but a median progression-free survival of <4 months still leaves room for improvement. Pomalidomide-based combination therapies are currently under investigation, but data on long-term treatment are lacking.
  
  
  METHODS
  We present the case of a 68-year-old woman with refractory MM who received pomalidomide in combination with various drugs including anthracyclines, alkylators and proteasome inhibitors. Initially, major hematological toxicities and infectious complications including a hepatitis B virus reactivation were encountered. With careful dose adjustments and selection of combination partners, pomalidomide treatment was maintained for over 4 years and led to a sustained partial remission. In particular, the well-tolerated regimen of bortezomib, cyclophosphamide and dexamethasone together with pomalidomide was administered for >30 cycles.
  
  
  CONCLUSIONS
  This case illustrates the value of an individualized approach to myeloma care given an increasing availability of 'novel agents'. Tailored treatment using these drugs as a backbone is essential to achieve long-lasting responses and minimize side effects.
authors.affiliation: Division of Hematology and Medical Oncology, Department of Internal Medicine, Wuerzburg University Medical Center, Wuerzburg, Germany.
authors.forename: Sophia
authors.initials: S
authors.lastname: Danhof
authors.affiliation: Division of Hematology and Medical Oncology, Department of Internal Medicine, Wuerzburg University Medical Center, Wuerzburg, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Schreder
authors.affiliation: Division of Hematology and Medical Oncology, Department of Internal Medicine, Wuerzburg University Medical Center, Wuerzburg, Germany.
authors.forename: Susanne
authors.initials: S
authors.lastname: Strifler
authors.affiliation: Division of Hematology and Medical Oncology, Department of Internal Medicine, Wuerzburg University Medical Center, Wuerzburg, Germany.
authors.forename: Hermann
authors.initials: H
authors.lastname: Einsele
authors.affiliation: Division of Hematology and Medical Oncology, Department of Internal Medicine, Wuerzburg University Medical Center, Wuerzburg, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Knop
keywords: Combination therapy; Hepatitis B virus reactivation; Multiple myeloma; Pomalidomide