Bendamustine in combination with thalidomide and dexamethasone is a viable salvage option in myeloma relapsed and/or refractory to bortezomib and lenalidomide

Ann Hematol. 2015 Apr;94(4):643-9. doi: 10.1007/s00277-014-2238-2. Epub 2014 Oct 28.

Abstract

Treatment options are limited in myeloma relapsed or refractory to both bortezomib and lenalidomide (double-relapsed/refractory multiple myeloma; DRMM). Bendamustine is an antitumour agent that has efficacy in relapsed myeloma. We retrospectively analysed data from 30 DRMM patients who received a combination of bendamustine, thalidomide and dexamethasone (BTD) in 28-day treatment cycles. Bendamustine was administered with a cumulative dose of up to 200 mg/m(2). Thalidomide (50-150 mg) was given daily as tolerated, and dexamethasone was given at an equivalent dose of up to 160 mg per cycle. A median of 5 (2-9) treatment cycles were administered per patient. Twenty-six patients (87 %) achieved stable disease or better. At a median follow-up time of 12.1 (2.3-21.5) months, median (95 % CI) progression-free survival and overall survival were 4.0 (2.6-5.3) months and 7.2 (5.2-9.2) months, respectively. The most common grade 3-4 adverse events were haematological: anaemia (n = 8, 34.8 %), neutropenia (n = 16, 69.6 %) and thrombocytopenia (n = 10, 43.5 %). Non-haematological toxicities included pain (n = 3, 13.0 %), infection (n = 7, 30.4 %) and sensory neuropathy (n = 1, 4.3 %). We propose that BTD is a viable salvage treatment option for DRMM patients.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use*
  • Bendamustine Hydrochloride
  • Boronic Acids / therapeutic use*
  • Bortezomib
  • Dexamethasone / administration & dosage*
  • Female
  • Humans
  • Lenalidomide
  • Male
  • Middle Aged
  • Multiple Myeloma / drug therapy*
  • Multiple Myeloma / mortality
  • Nitrogen Mustard Compounds / administration & dosage*
  • Pyrazines / therapeutic use*
  • Recurrence
  • Retrospective Studies
  • Salvage Therapy / methods*
  • Survival Analysis
  • Thalidomide / administration & dosage*
  • Thalidomide / analogs & derivatives*
  • Thalidomide / therapeutic use
  • Treatment Failure

Substances

  • Boronic Acids
  • Nitrogen Mustard Compounds
  • Pyrazines
  • Thalidomide
  • Bortezomib
  • Dexamethasone
  • Bendamustine Hydrochloride
  • Lenalidomide