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D(T) PACE as salvage therapy for aggressive or refractory multiple myeloma
Author(s) -
Gerrie Alina S.,
Mikhael Joseph R.,
Cheng Lu,
Jiang Haiyan,
Kukreti Vishal,
Panzarella Tony,
Reece Donna,
Stewart Keith A.,
Trieu Young,
Trudel Suzanne,
Chen Christine I.
Publication year - 2013
Publication title -
british journal of haematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.907
H-Index - 186
eISSN - 1365-2141
pISSN - 0007-1048
DOI - 10.1111/bjh.12325
Subject(s) - medicine , salvage therapy , regimen , etoposide , multiple myeloma , surgery , refractory (planetary science) , hematopoietic stem cell transplantation , dexamethasone , cohort , autologous stem cell transplantation , transplantation , oncology , chemotherapy , physics , astrobiology
Summary Dexamethasone ± thalidomide with infusion of cisplatin, doxorubicin, cyclophosphamide, and etoposide [D(T) PACE ] is generally reserved as salvage therapy for aggressive multiple myeloma ( MM ) or plasma cell leukaemia ( PCL ) resistant to conventional therapies. The efficacy and durability of this potentially toxic regimen in this setting is unclear. We identified 75 patients who received D(T) PACE for relapsed/refractory MM at two tertiary care centres: P rincess M argaret H ospital, T oronto and M ayo C linic A rizona. At time of D(T) PACE , 16 patients had PCL and three patients had leptomeningeal disease. Patients were heavily pretreated (median three prior regimens, range 1–12; prior autologous stem cell transplant [ ASCT ] 33%). Overall response rate was 49% (very‐good partial response 16%, partial response 33%) with stable disease in an additional 36%. Median progression‐free survival ( PFS ) was 5·5 months (95% confidence interval [ CI ]:4·3–9·8); overall survival ( OS ) 14·0 months (95% CI :8·7–19·3). Thirty‐five patients proceeded to ASCT or clinical trial, with median PFS for this subset of 13·4 months (95% CI :7·7–20·1) and OS 20·5 months (95% CI :14·8–63·8). D(T) PACE is an effective salvage therapy for heavily pretreated MM patients. Although the overall response rate of 49% in this poor prognosis cohort is reasonable, the PFS is short, suggesting the best role for D(T) PACE is in bridging to definitive therapy, such as transplantation.