Effectiveness of pomalidomide therapy in patient with multiple myeloma refractory to other immunomodulatory drugs

Abstract

Treatment of patients with refractory or relapse multiple myeloma (MM) is a major therapeutic challenge. The introduction to the therapy of new active drugs, such as immunomodulating drugs (IMiDs) or proteasome inhibitors contributed to a significant increase in the percentage and quality of the obtained responses and, most importantly, to the prolongation of patients’ life. However, MM is a disease with frequent progressions, and choosing the right treatment strategy is much more difficult with each subsequent relapse. The drugs used in the treatment of such patients include pomalidomide — an IMiD, registered in Poland as the third-line therapy for patients with relapsed and refractory MM. The paper presents a case report of a 66-year-old patient diagnosed with IgG lambda MM, who since January 2016 had received 5 lines of treatment with IMiDs, bortezomib and daratumumab, nevertheless she had not met the criteria of response to treatment. In May 2019, the patient was qualified for further treatment with pomalidomide in combination with low doses of oral dexamethasone (POM-DEX). During the treatment, a significant reduction in the level of the monoclonal IgG lambda protein was observed. After receiving two treatment cycles, the patient met the criteria for partial remission, and after 12 cycles the level of monoclonal protein decreased by 78% compared to the period before treatment. The therapy was quite well tolerated. The only side effects observed during treatment were: worse tolerance of physical effort, weight gain and slight edema of lower limbs. Due to the POM-DEX therapy, the patient achieved a durable response to the treatment, despite the rapid relapses of the disease during the previous lines of treatment.