Akademik Veri Yönetim Sistemi
8. International Congress on Leukemia Lymphoma Myeloma, 21 - 22 Mayıs 2021, sa.74, ss.50-51
Introduction: Multiple myeloma (MM) is a plasma cell malignancy with
propensity to cause bone lesions, hypercalcemia, renal failure and anemia.
Treatmen options in multiple myelome changing. With the availability of
novel chemotherapeutic agents including proteasome inhibitors (PIs), and
immunomodulatory drugs (IMiDs), and increased use of high dose therapy
with autologous stem cell transplantation (ASCT), the overall survival (OS) in
patients with MM has improved.(1.2). Patients with multiple relapses and/
or refractory MM (RRMM) are difficult to manage as the therapeutic options
become limited and the response to new therapy resulted in lower response
rate and shorter duration. (3) In eligible patients, PACE (cisplatin, doxorubicin, cyclophosphamide, and etoposide) regimens is often utilized.
Patients and Methods: 12 patients with multiple myeloma who were followed
up in Dokuz Eylül University Hematology Unit were included in the study.We
analyzed the outcomes of 13 patients with RRMM who received PACE regimens
at our center between 2019 and 2021 in an intent-to-treat analysis.
Results: Median age was 51 years, and 66.7% male. Patients have diagnosed
between 2012 and 2019 and received PACE regimens at a median of 50
months from diagnosis. Patients were heavily pretreated with a median of
5 prior regimens (range, 2-8), prior autologous stem cell transplant [ASCT]
(except one). PACE regimens of patient were listed in Table I.
Patients who were not completed therapy due to toxicity and died in a short
time were excluded. 1 patient achieved Complete Response (CR) (%8.3) ,
5 of patients achieved Partial Response (PR) (%41,7), 1 patient achieved
Minimal Response (MR) (%8,3). Alternative treatments were started after 1
course due to renal failure and gram negative infection in 1 patient, grade
4 neutropenia and opportunistic infection in 1 patient. 3 patients died in 1
month. 2 due to toxic hepatitis and sepsis, 1 due to sepsis. 3 patient)s with PR
and CR underwent allogenic stem cell transplantation. One of them died 1
month after AKIT due to Graft versus host disease (GVHD) and Venooclusive
disease (VOD).7 patients (%58) had extramedullary involvement. Median overall survival
of patients after pace regimens were 7 months (Figure I). 5 patients are still
alive. Median progression free survival of patients after pace regimens were
4 months (Figure II).
Conclusion: In patients for suitable PACE like regimens have a high response
rate even if they were heavily pretreated (4). PACE like regimens can be modified by adding novel agents to the regimen. Their use can be considered in
heavily pretreated patients especially if they have extramedullary disease
manifestations. And may be a bridge therapy for allogenic transplatation.