The role of pomalidomide in treatment of relapse and refractory multiple myeloma

Abstract

Background. Over the past 15 years, the therapeutic breakthrough in the treatment of multiple myeloma observed primarily due to the emergence of new drugs. Since the characteristic of the disease is a chronic course with consecutive periods of remissions and relapses, the search for new effective treatment options with each subsequent relapse/progression is critical to increasing the survival of patients.Objective: to evaluate the role of pomalidomide in the treatment of relapsed/refractory multiple myeloma.Materials and methods. The results’ analysis of using pomalidomide-based treatment (Pd (pomalidomide/dexamethasone), PVd (pomalidomide/bortezomib/dexamethasone), KPd (carfilzomib/pomalidomide/dexamethasone), IxaPd (ixazomib/pomalidomide/dexamethasone), DaraPd (daratumumab/pomalidomide/dexamethasone), IsaPd (isatuximab/ pomalidomide/dexamethasone), EloPd (elotuzumab/pomalidomide/dexamethasone)) in pretreated patients, including own data, was done. Based on the RosNIIGT FMBA of Russia, 17 patients with relapsed/refractory multiple myeloma were treated; the frequency of achieving a response and the development of adverse events was estimated; the possibility of pomalidomide dose reducing with the development of adverse events was described without an apparent decrease of effectiveness.Results. The frequency of the overall response in using pomalidomide-based programs was 53 % (according to the world data, from 38 to 82 %). This drug is recommended for patients with multiple myeloma, even accompanied by the final stages of renal failure. The most frequent adverse event was grade III–IV neutropenia (30 % of patients). In 3 patients, the dosage of pomalidomide was adjusted with a decrease to 2 mg per day. In 2 patients, therapy was discontinued due to pulmonary embolism and bilateral pneumonia. After three courses of DaraPd, one patient achieved a complete response and underwent autologous hematopoietic stem cell transplantation.Conclusion. Pomalidomide-based programs in patients with relapsed/refractory multiple myeloma are an effective treatment option. Using dose-adjusted pomalidomide after the occurrence of neutropenia makes it possible to normalize the neutrophils level (more than 1 × 109/l) and continue anti-myeloma therapy, preserving the therapeutic effect and in individual patients with unfavorable prognosis factors to conduct high-dose therapy followed by autologous hematopoietic stem cell transplantation.