Abstract 5143

The RVD regimen has shown a promising activity in patients with relapsed/refractory multiple myeloma (MM). In the present study, we report preliminary results on 14 patients in first relapse after autologous stem cell transplantation (ASCT) treated by VRD followed by a maintenance treatment with revlimid-dexamethasone (Rev-dex) in responder-patients.

Treatment was as follows: RVD included lenalidomide 15 mg per day (d) d1 through d14, bortezomib 1 mg/m2 on d1,4,8 and 11 and dexamethasone 20 mg on d1,2,4,5,8,9,11 and 12 of 21-d cycles with the objective to deliver at least 6 cycles. A maintenance treatment by Rev-dex with lenalidomide 25 mg d1 to d21 plus dexamethasone 20 mg weekly of d-28 cycles, delivered until progression was planned in patients achieving at least partial response to RVD.

Patients' characteristics at relapse: median age was 65 years (range 59 to 70), median time to relapse following ASCT before RVD was 26 months (range 4 to 86). All pts were naive for lenalinomide and 8 for bortezomib. Translocation t(4;14) was observed in 4 patients and was associated with del(17p13) in one case.

Patients received a median number of 6 cycles of RVD (range 3 to 8). Overall response rate was 71% and 43% of the patients achieved very good partial or better response. Discontinuation of RVD was due to disease progression in 4 cases. During RVD treatment, 4 patients (29%) experienced grade 3–4 adverse events: neutropenia n =2, thrombocytopenia n=1, thrombosis n=1. Following RVD, 10 patients received Rev-dex maintenance.

With a median follow-up of 15 months (range 6 to 29), 11 patients are alive free of evolutive disease. Four patients progressed during VRD: one with solitary plasmocytoma was efficiently treated by radiotherapy, the 3 other patients received anthracycline or platin based regimens but were refractory and 2 of them died. One patient progressed during maintenance and was efficiently treated by melphalan-cyclophosphamide-dexamethasone. Among the 4 patients with high-risk cytogenetic abnormalities, one CR, one PR and 2 progressions were observed during RVD. The first patient remains in CR 16 months after the beginning of salvage treatment.

Conclusion:

RVD followed by Rev-dex maintenance is a promising therapeutic option in MM patients in first relapse after ASCT with low toxicity profile.

Disclosures:

No relevant conflicts of interest to declare.

Topics:
autologous stem cell transplant, bortezomib, dexamethasone, lenalidomide, multiple myeloma, adverse event, anthracycline antibiotics, brachial plexus neuritis, cyclophosphamide, disease progression

Author notes

*

Asterisk with author names denotes non-ASH members.

© 2011 by The American Society of Hematology
2011
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