title: Safety and tolerability of pomalidomide-based regimens (pomalidomide-carfilzomib-dexamethasone with or without cyclophosphamide) in relapsed/refractory multiple myeloma and severe renal dysfunction: a case series.
abstract: Renal dysfunction negatively impacts outcomes in patients with multiple myeloma (MM). Few treatment options are currently available for patients with MM and comorbid renal dysfunction, and as they are generally excluded from clinical trials, data on the use of immunomodulatory drugs in this population are scarce. In this paper, we describe a case series of five women with MM and severe renal dysfunction or dialysis dependency who were refractory to both bortezomib and either lenalidomide or thalidomide and were treated with full-dose (4 mg) pomalidomide. As part of their treatment regimen, these patients also received carfilzomib and dexamethasone with or without cyclophosphamide. All five patients achieved at least a partial response to pomalidomide-based therapy, which was relatively well tolerated. Our findings suggest that pomalidomide may represent a valuable and tolerable treatment option for MM patients with severe renal impairment. The fact that pomalidomide is extensively metabolized prior to urinary excretion may explain the improved tolerability of pomalidomide versus lenalidomide in such patients. Copyright © 2016 John Wiley & Sons, Ltd.
authors.affiliation: Hackensack University Medical Center, Hackensack, NJ, 07601, USA.
authors.forename: Joshua
authors.initials: J
authors.lastname: Richter
authors.affiliation: Hackensack University Medical Center, Hackensack, NJ, 07601, USA.
authors.forename: Noa
authors.initials: N
authors.lastname: Biran
authors.affiliation: Hackensack University Medical Center, Hackensack, NJ, 07601, USA.
authors.forename: Narjust
authors.initials: N
authors.lastname: Duma
authors.affiliation: Hackensack University Medical Center, Hackensack, NJ, 07601, USA.
authors.forename: David H
authors.initials: DH
authors.lastname: Vesole
authors.affiliation: Hackensack University Medical Center, Hackensack, NJ, 07601, USA.
authors.forename: David
authors.initials: D
authors.lastname: Siegel
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D003520:Cyclophosphamide / Q000008:administration & dosage; D003907:Dexamethasone / Q000008:administration & dosage; D005260:Female; D006801:Humans; D007674:Kidney Diseases / Q000209:etiology; D008875:Middle Aged; D009101:Multiple Myeloma / Q000150:complications / Q000188:drug therapy*; D009842:Oligopeptides / Q000008:administration & dosage; D012008:Recurrence; D013792:Thalidomide / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives
chemical_list: D009842:Oligopeptides; D013792:Thalidomide; C524865:carfilzomib; D003907:Dexamethasone; D003520:Cyclophosphamide; C467566:pomalidomide
keywords: immunotherapy; multiple myeloma; pomalidomide; renal dysfunction; salvage therapy