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Background. The development of radical therapy for multiple myeloma (MM) is still a pressing problem. This progressive disease requires repeated courses of therapy using drugs without cross-resistance. The prognosis of “double refractory” MM which is resistant to key antitumor drugs, fi rst generation protease inhibitors and immunomodulating agents, remains poor. The median progression-free survival (PFS) and overall survival (OS) in this cohort of patients are 5 and 9 months, respectively. Aim. The aim was to assess the eff ectiveness and tolerability of pomalidomide in combination with low-dose of dexamethasone in “double refractory” relapsed/refractory multiple myeloma (RRMM). Materials & Methods. According to study protocol, 10 patients from Hematology Research Center and Federal Almazov North-West Medical Research Centre with RRMM were included in the period from September 2015 to July 2016. The median age was 62.5 years (range 48– 76 years), and the median number of therapy lines was 4 (range 3–5). All patients had a disease progression after the administration of bortezomib, lenalidomide, and alkylating agents. In addition, 6 (60 %) of 10 patients received high-dose melphalan chemotherapy followed by autoHSCT. The median number of therapy lines was 6 (range 4–15). Results. The overall response rate was 60 % and the minimum response (stabilization of the disease) was observed in 40 % of patients (IMWG criteria). The median PFS was 7.8 months; OS in 18 months was observed in 70 % of cases (the median not achieved). Treatment-associated grade III–IV hematologic toxicity was observed in 2 patients (5 episodes). Non-hematological adverse events of grade III–IV included acute coronary syndrome, deep vein thrombosis, neuropathic pain, and in 1 case acute delusional disorder, which required discontinuation of the therapy. The presence of ini373 ht tp : / /b lood journa l . ru / Помалидомид при ММ 70 % (медиана не достигнута). Гематологическая токсичность III–IV степени, связанная с терапией, наблюдалась у 2  больных (5  эпизодов). Негематологические нежелательные явления III–IV степени включали острый коронарный синдром, тромбоз глубоких вен нижних конечностей, нейропатическую боль, а также острое бредовое расстройство в 1 наблюдении, потребовавшее прекращения терапии. Наличие исходной цитопении и почечной недостаточности до начала терапии помалидомидом не потребовало редукции доз препарата и/или прекращения лечения. Заключение. Исследуемый режим, включающий помалидомид и малые дозы дексаметазона, продемонстрировал высокий уровень общего ответа при РРММ, а также приемлемый профиль токсичности. Ключевые слова: множественная миелома, «двойная рефрактерность», иммуномодулирующие препараты, помалидомид. Получено: 24 января 2017 г. Принято в печать: 6 мая 2017 г. Для переписки: Алексей Владиленович Петров, ул. Аккуратова, д. 2, Санкт-Петербург, Российская Федерация, 197341; тел.: +7(921)317-28-02; e-mail: avlpetrov@mail.ru Для цитирования: Петров А.В., Моторин Д.В., Покровская О.С. и др. Опыт применения помалидомида в комбинации с низкими дозами дексаметазона при множественной миеломе с «двойной рефрактерностью». Клиническая онкогематология. 2017;10(3):372–80. DOI: 10.21320/2500-2139-2017-10-3-372-380

Pomalidomide in Combination with Low-Dose Dexamethasone as the Treatment of "Double Refractory"