Abstract
Abstract 5142
The combination of an alkylating agent and bortezomib has been shown to be synergistic both preclinically and in the clinical arena. Although the combination of cyclophosphamide, bortezomib and corticosteroids (CyBorD) has been evaluated by several investigators, many have used different doses and schedule of cyclophosphamide and an optimal schedule has not been established. Herein, we report the safety and efficacy of this combination in patients with relapsed and refractory multiple myeloma.
All patients with myeloma that received this schedule of CyBorD at the Moffitt Cancer Center were included. CyBorD was comprised of cyclophosphamide 1000 mg/2 IV on Day 1, Bortezomib 1.3 mg/m2 IV on Days 1, 4, 8, and 11 and either low dose dexamethasone (equivalent of 120– 160mg/cycle) or prednisone (100 mg PO day 1–5). Demographic, laboratory and clinical data was collected and evaluated via descriptive statistics. Response and progression are defined as per the IMWG uniform response criteria.
A total of 20 patients were identified and included for analysis. Demographic data is shown in table 1. At baseline, 35% of patients were platelet transfusion dependent, and the median ß2m was 6.2mg/L. 8 patients (40%) received prophylactic GCSF and 9 patients (45%) received secondary GCSF after significant neutropenia was noted. Overall response rate (PR and better) was 50% (70% minimal response and better), including 1 complete response (CR) and 5 very good partial response (VGPR). Median progression free survival was 3.4 months (95% CI 0–7.5 months) and median overall survival was 11.9 months (95% CI 3.3–20.0). The incidence of grade 3/4 neutropenia and thrombocytopenia was 80% and 75%, respectively. Grade 2 and 3 peripheral neuropahty developed in 1 and 1 patient respectively. Nine patients required dose reductions of cyclophosphamide (only 2 of the 8 who received prophylactic GCSF therapy) and 3 patients required dose reductions of the bortezomib.
| . | n = 20 . |
|---|---|
| Age – years, median (range) | 60 (47–77) |
| Gender – male, n (%) | 12 (60%) |
| Years from diagnosis, median (range) | 2 (0–13) |
| Heavy chain, n (%) | |
| IgG | 10 (50%) |
| IgA | 8 (40%) |
| Light chain MM | 2 (10%) |
| Kappa light chain | 14 (70%) |
| ECOG PS, n (%) | |
| 0 | 2 (10%) |
| 1 | 9 (45%) |
| 2 | 9 (45%) |
| Transfusion requirement at baseline | |
| RBC, n (%) | 9 (45%) |
| Platelets, n (%) | 7 (35%) |
| No. of prior therapy, median (range) | 3 (1–6) |
| Prior Bortezomib, n (%) | 12 (60%) |
| Bortezomib refractory, n (%) | 4 (20%) |
| Prior lenalidomide, n (%) | 15 (75%) |
| Prior HDT, n (%) | 7 (35%) |
| Prior Alkylator, n (%) | 8 (40%) |
| Serum β2M, median (range) mg/L | 6.2 (2.3–21.7) |
| Serum Creatinine > 2 mg/dL, n (%) | 4 (20%) |
| Baseline platelet count x 103/μL | 54 (14–233) |
| Median # cycles | 4 |
| . | n = 20 . |
|---|---|
| Age – years, median (range) | 60 (47–77) |
| Gender – male, n (%) | 12 (60%) |
| Years from diagnosis, median (range) | 2 (0–13) |
| Heavy chain, n (%) | |
| IgG | 10 (50%) |
| IgA | 8 (40%) |
| Light chain MM | 2 (10%) |
| Kappa light chain | 14 (70%) |
| ECOG PS, n (%) | |
| 0 | 2 (10%) |
| 1 | 9 (45%) |
| 2 | 9 (45%) |
| Transfusion requirement at baseline | |
| RBC, n (%) | 9 (45%) |
| Platelets, n (%) | 7 (35%) |
| No. of prior therapy, median (range) | 3 (1–6) |
| Prior Bortezomib, n (%) | 12 (60%) |
| Bortezomib refractory, n (%) | 4 (20%) |
| Prior lenalidomide, n (%) | 15 (75%) |
| Prior HDT, n (%) | 7 (35%) |
| Prior Alkylator, n (%) | 8 (40%) |
| Serum β2M, median (range) mg/L | 6.2 (2.3–21.7) |
| Serum Creatinine > 2 mg/dL, n (%) | 4 (20%) |
| Baseline platelet count x 103/μL | 54 (14–233) |
| Median # cycles | 4 |
In this cohort of patients with high burden of disease, intermediate dose cyclophosphamide administered once every 3 weeks in combination with standard dose and schedule of bortezomib results in a meaningful response rate (albeit short PFS) with mainly hematologic toxicities that are manageable with growth factor support.
Off Label Use: Cyclophosphamide in combination with bortezomib for relapsed/refractory multiple myeloma. Finley-Oliver:Millenium: Speakers Bureau. Alsina:Millennium: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding; Novartis: Consultancy, Membership on an entity's Board of Directors or advisory committees; Allergan: Research Funding. Djulbegovic:Millenium: Research Funding. Baz:Millenium: Research Funding, Speakers Bureau; Celgene: Research Funding.
Author notes
Asterisk with author names denotes non-ASH members.
