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Prashant Kapoor, MD, FACP


Palliative Chemoradiotherapy Regimen Under Study in Multiple Myeloma

By: Victoria Kuhr, BA
Posted: Wednesday, January 19, 2022

Radiation therapy administered concurrently with dexamethasone, cyclophosphamide, etoposide, and cisplatin (DCEP) to patients with multiple myeloma appears to be well tolerated, with low rates of hematologic and radiation therapy–related toxicity, according to Anthony D. Nehlsen, MD, of Icahn School of Medicine, Mount Sinai, New York, and colleagues. Additionally, researchers proposed that radiation therapy may be effective in relieving pain for many patients. A detailed report of the study was published in Clinical Lymphoma Myeloma and Leukemia.

“Our data suggest that there is little risk to the bone marrow when delivering radiation therapy concurrently with dexamethasone, cyclophosphamide, etoposide, and cisplatin and that chemotherapy can be safely continued during radiation treatments,” said the authors.

The study enrolled 55 patients with multiple myeloma from 2010 to 2022. All patients received radiation therapy at 64 different sites within 3 weeks of receiving DCEP. A median dose of 20 Gy (range, 8–32.5 Gy) was delivered in a median of 5 fractions (range, 1–15 fractions). Patients received a median of one cycle (range, 1–5 cycles) of DCEP. The study measured the rates of hematologic and radiation therapy toxicity; pain; as well as radiographic and laboratory responses to treatment.

Radiotherapy was completed in 98% of patients. A total of 21% of patients experienced RTOG grade 3+ hematologic toxicity before radiotherapy, which increased to 35% 1 month after therapy (P = .13) before decreasing to 12% at 3 to 6 months (P = .02). The most common toxicity reported was thrombocytopenia. Grade 1 or 2 nonhematologic radiotherapy-related toxicity was reported in 15% of patients while on treatment, but the rate fell to 6% 1 month after completion of radiation therapy. Pain resolved in 94% of patients with symptomatic lesions at baseline. Stable disease or better was observed in 34 of 39 (87%) of the targeted lesions on surveillance imaging.

Disclosure: The study authors reported no conflicts of interest.

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