PACE as salvage therapy for relapsed or refractory multiple myeloma

Isola, Ignacio; Granell, Miguel; Martı́, Josep; Gironella, Merche; Garcia-Guiñon, Antonio; López-Pardo, Jordi; Muntañola, Ana; Abella, Eugènia; Motlló, Cristina; Escoda, Lourdes; Sierra, Jorge; Bladé, Joan; Rosiñol, Laura; Larrea, Carlos Fernández de

doi:10.1016/j.clml.2015.07.609

Cited by 3 publications

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“…High-dose melphalan followed by autologous stem cell transplantation (ASCT), the treatment recommended for young and fit patients, has severe neutropenia and infection rates up to 77% and 30%, respectively [19][20][21]. Other chemotherapeutic combinations used only in highly aggressive disease or in multiple refractory patients, such as VTD-PACE (bortezomib, thalidomide, dexamethasone and cisplatin, doxorubicin, cyclophosphamide, and etoposide) or PACE (cisplatin, doxorubicin, cyclophosphamide, and etoposide) show neutropenia rates of 79% and 83%, respectively, and FN rates of 26% and 33%, respectively [22,23]. Novel agents such as thalidomide, lenalidomide, and, more recently, pomalidomide (IMiD) are now the backbone of treatment for newly diagnosed and relapsed MM.…”

Section: Neutropenia and Fn In Multiple Myelomamentioning

confidence: 99%

Pegfilgrastim for primary prophylaxis of febrile neutropenia in multiple myeloma

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Martinelli

2021

Support Care Cancer

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Multiple myeloma (MM) survival rates have been substantially increased thanks to novel agents that have improved survival outcomes and shown better tolerability than treatments of earlier years. These new agents include immunomodulating imide drugs (IMiD) thalidomide and lenalidomide, the proteasome inhibitor bortezomib (PI), recently followed by new generation IMID pomalidomide, monoclonal antibodies daratumumab and elotuzumab, and next generation PI carfilzomib and ixazomib. However, even in this more promising scenario, febrile neutropenia remains a severe side effect of antineoplastic therapies and can lead to a delay and/or dose reduction in subsequent cycles. Supportive care has thus become key in helping patients to obtain the maximum benefit from novel agents. Filgrastim is a human recombinant subcutaneous preparation of G-CSF, largely adopted in hematological supportive care as “on demand” (or secondary) prophylaxis to recovery from neutropenia and its infectious consequences during anti-myeloma treatment. On the contrary, pegfilgrastim is a pegylated long-acting recombinant form of granulocyte colony-stimulating factor (G-CSF) that, given its extended half-life, can be particularly useful when adopted as “primary prophylaxis,” therefore before the onset of neutropenia, along chemotherapy treatment in multiple myeloma patients. There is no direct comparison between the two G-CSF delivery modalities. In this review, we compare data on the two administrations’ modality, highlighting the efficacy of the secondary prophylaxis over multiple myeloma treatment. Advantage of pegfilgrastim could be as follows: the fixed administration rather than multiple injections, reduction in neutropenia and febrile neutropenia rates, and, finally, a cost-effectiveness advantage.

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Section: Neutropenia and Fn In Multiple Myelomamentioning

confidence: 99%

Pegfilgrastim for primary prophylaxis of febrile neutropenia in multiple myeloma

Cerchione

Nappi

Martinelli

2021

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“…Other regimens associated with very high levels of neutropenia were bortezomib, thalidomide, dexamethasone and cisplatin, doxorubicin, cyclophosphamide and etoposide (VTD-PACE) in patients with NDMM, and cisplatin, doxorubicin, cyclophosphamide and etoposide (PACE) in patients with RRMM, which resulted in neutropenia rates of 79 and 83% and febrile neutropenia rates of 26 and 33%, respectively [ 72 , 73 ].…”

Section: Regimens Associated With a Very High Incidence Of Neutropenimentioning

confidence: 99%

Incidence of neutropenia and use of granulocyte colony-stimulating factors in multiple myeloma: is current clinical practice adequate?

et al. 2017

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Although immunomodulatory drugs, alkylating agents, corticosteroids, protease inhibitors, and therapeutic monoclonal antibodies improve multiple myeloma outcomes, treatment burden is still an issue. Neutropenia is a known complication of cytotoxic cancer therapy and is often associated with infections; it is an important consideration in myeloma given the fact that patients often have a weakened immune system. The risk of febrile neutropenia increases with severe and persisting neutropenia. Recombinant granulocyte colony-stimulating factors (G-CSFs) are commonly used to reduce the incidence, duration, and severity of febrile neutropenia. Here, we review the risk and management of neutropenia associated with new and commonly used anti-myeloma agents. Few papers report the use of G-CSF in patients with multiple myeloma receiving anti-cancer treatments, and fewer describe whether G-CSF was beneficial. None of the identified studies reported G-CSF primary prophylaxis. Further studies are warranted to evaluate the need for G-CSF prophylaxis in multiple myeloma. Prophylaxis may be particularly useful in patients at high risk of prolonged severe neutropenia.Electronic supplementary materialThe online version of this article (10.1007/s00277-017-3191-7) contains supplementary material, which is available to authorized users.

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How to Manage Patients with Lenalidomide-Refractory Multiple Myeloma

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Gaisán

Rubia

2022

Cancers

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Although lenalidomide-based combinations, such as lenalidomide plus a proteasome inhibitor or an anti-CD38 monoclonal antibody, improve the overall response rate, progression-free survival, and overall survival of patients with relapsed/refractory multiple myeloma (RRMM), there is a tendency to use these regimens as a frontline treatment. This strategy has led to the development of refractoriness early in the disease course, usually after the patient’s first treatment. Since lenalidomide-free regimens have so far shown limited efficacy in lenalidomide-refractory patients, there is an unmet need for other treatment options. In this review, we discuss the therapeutic options available to treat the general population of lenalidomide-refractory patients (mono, double and triple refractory) and the subpopulation of patients with other high-risk features such as renal failure, extramedullary disease, and high-risk cytogenetics. Moreover, new promising individual therapies and the possible impact of immunotherapy in RRMM patients are debated.

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PACE as salvage therapy for relapsed or refractory multiple myeloma

Cited by 3 publications

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Pegfilgrastim for primary prophylaxis of febrile neutropenia in multiple myeloma

Pegfilgrastim for primary prophylaxis of febrile neutropenia in multiple myeloma

Incidence of neutropenia and use of granulocyte colony-stimulating factors in multiple myeloma: is current clinical practice adequate?

How to Manage Patients with Lenalidomide-Refractory Multiple Myeloma

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