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Prashant Kapoor, MD, FACP


Combination Immunochemotherapy for Resistant Myeloma: Focus on Extramedullary Disease

By: Joshua D. Madera, MS
Posted: Monday, February 27, 2023

For patients with extramedullary multiple myeloma, the use of immunochemotherapy may serve as an alternative therapeutic option, according to the results of a phase II trial published in the Journal of Hematology & Oncology. Specifically, combination therapy with dexamethasone, cyclophosphamide, etoposide, and cisplatin (DCEP) plus the monoclonal antibody daratumumab showed clinical activity in this patient population, suggesting the treatment’s efficacy, explained Youngil Koh, MD, PhD, of Seoul National University Hospital, Korea, and colleagues.

A total of 32 patients with extramedullary multiple myeloma were recruited for the study. All patients had relapsed or refractory disease to bortezomib, as determined by the International Myeloma Working Group criteria. To confirm enrollment, patients needed to exhibit evidence of measurable disease upon CT screening. Study participants were administered three cycles of induction therapy and five cycles of maintenance therapy with daratumumab plus DCEP. In addition, they were initially given weekly daratumumab during weeks 1 through 8, and the dose was subsequently reduced to biweekly doses during weeks 9 through 12.

The study findings yielded an overall response rate of 67.7% and a complete remission rate of 35.5%. At a median follow-up of 11 months, the median overall survival and median progression-free survival were 10 months and 5 months, respectively. Seven patients were unable to achieve the median progression-free survival.

Moreover, thrombocytopenia was the most common hematologic adverse effect. Nonhematologic adverse effects included stomatitis (12.6%), diarrhea (12.6%), dyspepsia (12.6%), and nausea (22.6%). Furthermore, daratumumab-related infusion reactions were reported in 9.7% of patients.

“We successfully laid grounds for implementing immunochemotherapy in extramedullary multiple myeloma treatment,” the investigators concluded.

Disclosure: The study authors reported no conflicts of interest.

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