Addition of Cyclophosphamide “On Demand” to Lenalidomide and Corticosteroids in Patients With Relapsed/Refractory Multiple Myeloma—A Retrospective Review of a Single-center Experience

Alahmadi, Majed; Masih‐Khan, Esther; Atenafu, Eshetu G.; Chen, Christine; Kukreti, Vishal; Tiedemann, Rodger E.; Trudel, Suzanne; Reece, Donna

doi:10.1016/j.clml.2018.12.007

Cited by 4 publications

(4 citation statements)

References 29 publications

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“…Finally, the recognition that relapse in some patients can be attributed to the dominance of one of the multiple clones present at diagnosis, while the others may still be suppressed by ongoing therapy, provides another rationale for simply adding agents to LM at progression 24 . Other reports in the relapsed and refractory, rather than maintenance, setting have also demonstrated the favourable effect of increasing the dose and/or adding cyclophosphamide “on demand” to lenalidomide at subsequent progression 33,34 . These studies, along with the current analysis, support the continued incorporation of lenalidomide in patients experiencing disease progression on LM and emphasise the need to identify which patients will benefit the most from this approach.…”

Section: Discussionsupporting

confidence: 66%

“…24 Other reports in the relapsed and refractory, rather than maintenance, setting have also demonstrated the favourable effect of increasing the dose and/or adding cyclophosphamide "on demand" to lenalidomide at subsequent progression. 33,34 These studies, along with the current analysis, support the continued incorporation of lenalidomide in patients experiencing disease progression on LM and emphasise the need to identify which patients will benefit the most from this approach.…”

Section: Discussionmentioning

confidence: 59%

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The impact of lenalidomide maintenance on second‐line chemotherapy in transplant eligible patients with multiple myeloma

Cherniawsky

Kukreti

Reece

et al. 2021

European J of Haematology

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Objectives To understand the impact of therapy sequencing on progression‐free (PFS) and overall survival (OS) for the treatment of multiple myeloma (MM). The use of daily, low‐dose, lenalidomide maintenance (LM) has raised concern for fostering resistance, preventing its use in the relapsed setting. Methods We conducted a retrospective analysis of survival outcomes from the Canadian Myeloma Research Group Database. Patients were grouped based on receipt of LM after autologous stem cell transplant and receipt of lenalidomide in second‐line therapy, 575 patients were included. Results Patients treated with LM had statistically similar 2nd PFS when re‐exposed to lenalidomide in second‐line therapy compared to those receiving non‐lenalidomide‐containing regimens (10.2 vs 14.0 months, P =.53). This cohort also had the longest 2nd OS, 18 months longer than patients treated with LM who did not receive lenalidomide at relapse (55.3 vs 37 months, P =.004). Patients treated with LM also demonstrated deeper responses to second‐line therapy than their non‐LM counterparts. Conclusion Our data suggest that patients progressing on LM who receive lenalidomide‐containing therapy at first relapse have comparable 2nd PFS and better 2nd OS compared to non‐lenalidomide‐containing second‐line regimens. Identification of patients mostly likely to benefit from further lenalidomide‐containing therapy is paramount.

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Section: Discussionsupporting

confidence: 66%

Section: Discussionmentioning

confidence: 59%

The impact of lenalidomide maintenance on second‐line chemotherapy in transplant eligible patients with multiple myeloma

Cherniawsky

Kukreti

Reece

et al. 2021

European J of Haematology

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“…Median OS was 18 months from the addition of cyclophosphamide and PFS was 13 months 79 . Another center reported SD or better in 87% of 53 patients who had weekly cyclophosphamide, at a dose of 250–500 mg, added to len/dex at the time of progression 80 …”

Section: Immunomodulatory Role Within MM Treatment Regimens – Synergy...mentioning

confidence: 99%

“…79 Another center reported SD or better in 87% of 53 patients who had weekly cyclophosphamide, at a dose of 250-500 mg, added to len/dex at the time of progression. 80 Cyclophosphamide also shows synergy with pomalidomide. A randomized phase 1/2 trial compared pomalidomide and dexamethasone (pom/dex) with or without 400 mg of weekly oral cyclophosphamide.…”

Section: Immunomodulatory Agents (Imids)mentioning

confidence: 99%

Beyond DNA Damage: Exploring the Immunomodulatory Effects of Cyclophosphamide in Multiple Myeloma

et al. 2020

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The alkylating agent cyclophosphamide has been used in the treatment of multiple myeloma for over 60 years. At low doses, cyclophosphamide also has significant immunomodulatory activity, which can be used to modify the immunosuppressive tumor microenvironment in order to augment responses to existing therapies. Immune-mediated therapies are becoming more widespread in modern approaches to myeloma treatment. In this review, we discuss the effects cyclophosphamide has on the immune system, and how it can be used synergistically with other treatment modalities including the immunomodulatory agents, monoclonal antibodies and cellular therapies.

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Cyclophosphamide/dexamethasone/lenalidomide

2020

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Addition of Cyclophosphamide “On Demand” to Lenalidomide and Corticosteroids in Patients With Relapsed/Refractory Multiple Myeloma—A Retrospective Review of a Single-center Experience

Cited by 4 publications

References 29 publications

The impact of lenalidomide maintenance on second‐line chemotherapy in transplant eligible patients with multiple myeloma

The impact of lenalidomide maintenance on second‐line chemotherapy in transplant eligible patients with multiple myeloma

Beyond DNA Damage: Exploring the Immunomodulatory Effects of Cyclophosphamide in Multiple Myeloma

Cyclophosphamide/dexamethasone/lenalidomide

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