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Adding Cyclophosphamide to Lenalidomide/Dexamethasone in Resistant Myeloma

By: Joseph Fanelli
Posted: Wednesday, March 13, 2019

Adding oral cyclophosphamide to a regimen of lenalidomide and dexamethasone may be an inexpensive therapeutic option with manageable toxicity potentially resulting in a clinically meaningful extension of disease control for patients with relapsed or refractory multiple myeloma. These findings of a retrospective review of a single-center expeience were published in Clinical Lymphoma, Myeloma & Leukemia. Donna E. Reece, MD, of the Princess Margaret Cancer Centre in Toronto, and colleagues recommended future studies to investigate the immunomodulatory effects of cyclophosphamide with immunomodulatory and other immune therapies.

“A randomized national Canadian trial has recently begun, which has combined the monoclonal antibody daratumumab with low-dose [cyclophosphamide] and dexamethasone, with pomalidomide included initially versus ‘on-demand’ at next disease progression,” the authors added.

The authors conducted a retrospective medical record review of 53 patients with relapsed multiple myeloma who had received lenalidomide and dexamethasone plus cyclophosphamide for at least 4 weeks after disease progression with lenalidomide/dexamethasone alone. Of the patients, 80% had undergone previous autologous stem cell transplantation.

A clinical benefit was observed in 87% of patients, with an overall rate of response equal to or better than a partial response of 34%. The median duration of lenalidomide/dexamethasone plus cyclophosphamide therapy was 6.9 months, with a median progression-free survival of 6.1 months with the addition of cyclophosphamide and 24.1 months from the start of lenalidomide/dexamethasone.

Disclosure: The study authors’ disclosure information may be found at clinical-lymphoma-myeloma-leukemia.com.



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