Abstract
VD-PACE As Salvage and Bridging Therapy to Transplant and Cellular Therapy in Triple Class Relapsed/Refractory Multiple Myeloma
Transplantation and cellular therapy, Vol.30(2 Supplement), pp.S389-S390
02/2024
DOI: 10.1016/j.jtct.2023.12.545
Abstract
Patients that have triple-class relapsed/refractory multiple myeloma (RRMM) have relapsed on each of the following classes: immunomodulatory drugs, proteasome inhibitors, and an anti-CD38 monoclonal antibody. RRMM poses a significant challenge with poor prognosis due to limited options. We evaluated VD-PACE (bortezomib, dexamethasone, cisplatin, doxorubicin, cyclophosphamide, etoposide) for efficacy and safety as salvage therapy in heavily pretreated RRMM.
We retrospectively analyzed 54 patients who had triple-class RRMM and received at least 1 cycle of VD-PACE from June 2016 to July 2023 at the University of Kansas Health System in collaboration with the US Myeloma Innovations Research Collaborative. VD-PACE consisted of bortezomib 1 mg/m2 subcutaneous on days 1, 4, 8 and 11, doxorubicin 10 mg/m2 continuous infusion (CI) days 1-4, cisplatin 10 mg/m2 CI days 1-4, cyclophosphamide 400 mg/m2 days 1-4 and etoposide 40 mg/m2 days 1-4. Adverse events were graded based on the CTCAE v5.0 criteria. Responses to therapy were evaluated using the International Myeloma Working Group criteria.
Patient characteristics are summarized in Table 1. The overall response rate (ORR) was 54%, 7 (13%) patients achieved ≥ VGPR. Median progression-free survival (PFS) was 4.67 months (95% CI, 2.97 to 8.40), while overall survival was 7.93 months (95% CI, 6.33 to 14.73), as shown in Figure 1. Efficacy in penta-RRMM (n=32) vs non-penta-RRMM subgroups (n=22), the ORR was 44% vs 68% respectively, while the median PFS was 2.67 months (95% CI, 2-7.6) vs 9.28 months (95% CI, 4.67-NA). Treatment post salvage therapy of VD-PACE included autologous/allogenic stem cell transplant (SCT), BCMA-directed therapies (CAR-T, T-cell engaging bispecific antibodies, and antibody-drug conjugates), other chemotherapies, and enrollment in clinical trials reported at 13%, 26%, 39% and 4%, respectively. 11% of patients proceeded to hospice due to disease progression.
Hematologic adverse events are summarized in Table 1. 69% (n=37) required RBC transfusions and 67% (n=36) required platelet transfusions. Neutropenic fever (NF) was reported in 33% (n=18). Most common infection-related complications were bacteremia in 24% of patients, followed by pneumonia in 20% of the patients. Following the initial hospitalization to receive treatment, the readmission rate within 60 days was 50% (n=27), with NF as the most common reason for admission (52%, n=14). Treatment-related mortality (TRM) in the first 30 days was reported in 6% (n=3), all due to severe sepsis.
Based on our retrospective study, VD-PACE is an effective salvage treatment in triple RRMM and can be used as a bridging therapy prior to CAR-T, enrollment in clinical trials or proceeding to SCT. However, careful selection of patients for this intensive therapy must be emphasized due to the observed TRM from infectious complications.
Details
- Title: Subtitle
- VD-PACE As Salvage and Bridging Therapy to Transplant and Cellular Therapy in Triple Class Relapsed/Refractory Multiple Myeloma
- Creators
- Priyanka Venkatesh - University of Kansas Medical CenterPolina Bellman - University of Kansas Medical CenterSara Shatnawi - Jordan University of Science and TechnologyYara Shatnawi - Jordan University of Science and TechnologyHira Shaikh - University of IowaChristopher Sun Strouse - University of IowaShebli Atrash - Levine Cancer InstituteHamza Hashmi - Medical University of South CarolinaMuhammad Umair Mushtaq - University of Kansas Medical CenterNausheen Ahmed - University of Kansas Medical CenterZahra Mahmoudjafari - University of Kansas Medical CenterAl-Ola Abdallah - University of Kansas Medical CenterLeyla Shune - University of Kansas Medical Center
- Resource Type
- Abstract
- Publication Details
- Transplantation and cellular therapy, Vol.30(2 Supplement), pp.S389-S390
- Publisher
- Elsevier Inc
- DOI
- 10.1016/j.jtct.2023.12.545
- ISSN
- 2666-6367
- eISSN
- 2666-6367
- Language
- English
- Date published
- 02/2024
- Academic Unit
- Hematology, Oncology, and Blood & Marrow Transplantation; Internal Medicine
- Record Identifier
- 9984559879102771
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