KRD-PACE Mobilization for Multiple Myeloma Patients With Significant Residual Disease Before Autologous Stem-Cell Transplantation.

Autor: Cowan AJ; Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA; Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA; Seattle Cancer Care Alliance, Seattle, WA., Green DJ; Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA; Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA; Seattle Cancer Care Alliance, Seattle, WA., Karami M; Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA; Seattle Cancer Care Alliance, Seattle, WA., Becker PS; Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA; Seattle Cancer Care Alliance, Seattle, WA; Division of Hematology, Department of Medicine, University of Washington, Seattle, WA., Tuazon S; Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA; Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA; Seattle Cancer Care Alliance, Seattle, WA., Coffey DG; Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA; Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA; Seattle Cancer Care Alliance, Seattle, WA., Hyun TS; Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA; Department of Pathology, University of Washington, Seattle, WA., Libby EN; Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA; Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA; Seattle Cancer Care Alliance, Seattle, WA., Gopal AK; Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA; Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA; Seattle Cancer Care Alliance, Seattle, WA., Holmberg LA; Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA; Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA; Seattle Cancer Care Alliance, Seattle, WA. Electronic address: lholmber@fredhutch.org.
Jazyk: angličtina
Zdroj: Clinical lymphoma, myeloma & leukemia [Clin Lymphoma Myeloma Leuk] 2020 Sep; Vol. 20 (9), pp. 602-609. Date of Electronic Publication: 2020 Apr 14.
DOI: 10.1016/j.clml.2020.04.002
Abstrakt: Background: Bortezomib has been incorporated into thalidomide and dexamethasone provided with cisplatin, doxorubicin, cyclophosphamide, and etoposide (PACE) as an intensive regimen before autologous stem-cell transplantation for multiple myeloma (MM). We examined MM patients at our center who received chemomobilization with a regimen that substituted carfilzomib and lenalidomide for bortezomib and thalidomide (KRD-PACE).
Patients and Methods: This was a retrospective study of 27 MM patients who received KRD-PACE for chemomobilization. Our analysis included patients who had circulating plasma cells (CPCs) by flow cytometry, ≥ 10% bone marrow plasma cells (BMPC), a monoclonal protein ≥ 1 g/dL, or an involved serum free light chain ≥ 10 mg/dL.
Results: The most common indication for KRD-PACE was BMPC ≥ 10% in 16 patients (60%), followed by CPCs in 11 (41%). The median (range) age was 61 (35-69) years, and the median (range) BMPC before treatment was 10% (5%-47%). The overall response rate was 43%, and a median (range) of 20.24 (8.08-69.88) × 10 6 CD34 + cells/kg were collected. CPC clearance rate was 50%, and the median reduction in BMPC was 75%. Two patients had sinus bradycardia and 5 (19%) had neutropenic fever.
Conclusion: KRD-PACE is an effective therapy to mobilize peripheral blood stem cells in MM patients with residual disease burden. This regimen was successful at clearing CPCs and reducing BMPC burden, with an overall response rate of 43%. Despite theoretical concern regarding the combination of 3 cardiotoxic agents, we observed a low frequency of cardiac issues.
(Published by Elsevier Inc.)
Databáze: MEDLINE
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