PB2180 EXPERIENCE VRD‐PACE‐LIKE REGIMEN IN PATIENTS WITH PRIMARY REFRACTORY MYELOMA FOR PERIPHERAL STEM CELL MOBILIZATION

• Published in: HemaSphere 2019-06, Vol.3 (S1), p.978-n/a
• Main Authors: Nakastoev, I., Ryzhko, V., Novikova, A., Balzhanova, Y., Grachev, A., Abramova, T., Samtcova, M., Vasilchenkova, P., Danilina, A., Kanaeva, M., Gribanova, E.
• Format: Article
• Language: English
• ISSN: 2572-9241; 2572-9241
• DOI: 10.1097/01.HS9.0000567200.29278.53

Background: High‐dose chemotherapy followed by autologous stem‐cell transplant (ASCT) is the current treatment in patients with multiple myeloma (MM). To obtain the effect of ASCT it is necessary to achieve a response to induction therapy. Lenalidomide‐based regimens as the second‐line therapy failed peripheral blood mobilization of CD34+ cells and increase the risk of its inadequate collection. Thus, intensive chemotherapy regimens as VRD‐PACE and its modifications are used to enhance treatment response and effective mobilization. Aims: To estimate safety and efficacy of VRD‐PACE‐like regimens for peripheral stem cell mobilization. Methods A total of 7 patients with primary refractory multiple myeloma were enrolled in the study. All patients received VRD‐PACE‐like regimens in conventional doses followed by granulocyte colony‐stimulating factor (G‐CSF 10 μg/kg/day) started after reducing leukocytes count ≤ 1.0 × 109/L. As mobilizing regimen in 3 patients was administred VRD‐PACE, 3–RD‐PACE and 1–KRD‐PACE. Results: A total of 7 patients with primary refractory myeloma were enrolled in the study. The median age was 51 (range 40–56 years), of them 3 were men. These patients didn’t receive suboptimal response to bortezomib‐based regimens. Therefore, administration of second‐line therapy was required. Patients received in average 6 cycles of chemotherapy (6–10) and three lines of therapy. At initiation treatment with VRD‐PACE only 1 patient had very good partial response (VGPR), 3–partial response (PR), 3–disease progression. One patient with VGPR had adverse cytogenetic abnormalities and for this reason was treated with VRD‐PACE. All patients who received VRD‐PACE‐like regimens achieved decline of serum monoclonal protein, of them 2 obtained VGPR. Mobilization failure was in 2 patients due to inadequate collection of CD34+ cells. Before mobilization each of these patients received only 2 lenalidomide‐based cycles. Afterwards, high‐dose cyclophosphamide‐based mobilization was performed and sufficient amount of CD34+ cells was received. In the others 5 patients CD34+ cells were collected enough for tandem ASCT (6–12.4 × 106/kg). VRD‐PACE‐like regimens were not associated with severe complications. Only 1 patient was diagnosed with parietal thrombosis of the common femoral vein and 1 patient had Herpes labialis. One patient needed packed red cell and platelet transfusion. Summary/Conclusion: VRD‐PACE‐like regimens are an effective option for treatment of refracto