Progressive refractory light chain amyloidosis and multiple myeloma patients are responsive to the addition of clarithromycin to IMiD based therapy.
Multiple myeloma (MM) and primary systemic light chain amyloidosis (AL) are both chronic plasma cell dyscrasias with different clinical expression but limited treatment options for relapsed refractory disease. We report the effect of the addition of clarithromycin on 31 MM and 17 AL with relapsed or refractory disease who had an insufficient response or disease progression while on an IMiD based therapy. In this high risk population, hematological response was reported in 48% of MM patients and 94% of AL patients. Responses were reported early in both groups (median 35 days) and were more sustained in AL patients. Adverse events were common and included mostly grade 1-2 fatigue, infections and abdominal discomfort. Cytopenias were common and cardiac complications were rare in both MM and AL patients. Clarithromycin-IMiD combination therapy appears to be both effective and safe in progressive MM and primarily in AL patients, although a prospective clinical trial is warranted to validate these results. Am. J. Hematol. 92:131-135, 2017. © 2016 Wiley Periodicals, Inc.
Department of Hematology, Hadassah Hebrew University Medical Center, Jerusalem, Israel.
Adir
A
Shaulov
Department of Hematology, Shaare-Zedek Medical Center, Jerusalem, Israel.
Chezi
C
Ganzel
Department of Hematology, Rambam Medical Center, Haifa, Israel.
Noam
N
Benyamini
Barzilai Medical Center, Ashkelon, Israel.
Yossef
Y
Barshay
Department of Hematology, Hadassah Hebrew University Medical Center, Jerusalem, Israel.
Neta
N
Goldschmidt
Department of Hematology, Hadassah Hebrew University Medical Center, Jerusalem, Israel.
David
D
Lavie
Department of Hematology, Hadassah Hebrew University Medical Center, Jerusalem, Israel.
Diana
D
Libster
Department of Hematology, Hadassah Hebrew University Medical Center, Jerusalem, Israel.
Alex
A
Gural
Department of Hematology, Hadassah Hebrew University Medical Center, Jerusalem, Israel.
Batia
B
Avni
Department of Hematology, Hadassah Hebrew University Medical Center, Jerusalem, Israel.
Moshe E
ME
Gatt
D000328:Adult; D000368:Aged; D000686:Amyloidosis / Q000150:complications / Q000188:drug therapy*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use; D017291:Clarithromycin / Q000008:administration & dosage / Q000494:pharmacology*; D018450:Disease Progression; D005221:Fatigue / Q000139:chemically induced; D005260:Female; D006801:Humans; D007147:Immunoglobulin Light Chains; D000075363:Immunoglobulin Light-chain Amyloidosis; D007239:Infections / Q000139:chemically induced; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000150:complications / Q000188:drug therapy*; D011500:Protein Synthesis Inhibitors / Q000627:therapeutic use; D012008:Recurrence; D016879:Salvage Therapy / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome
D007147:Immunoglobulin Light Chains; D011500:Protein Synthesis Inhibitors; D017291:Clarithromycin