Vol 11, No 4 (2020)
Case report
Published online: 2021-03-30

open access

Page views 673
Article views/downloads 311
Get Citation

Connect on Social Media

Connect on Social Media

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

Marta Masternak12, Marta Morawska12
Hematologia 2020;11(4):235-239.

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.  

Article available in PDF format

View PDF (Polish) Download PDF file

References

  1. Giannopoulos K, Dmoszyńska A. Szpiczak plazmocytowy. In: Gajewski P, Szczeklik A. ed. Interna Szczeklika 2019/2020. Medycyna Praktyczna, Kraków 2019: 1045–1049.
  2. Nowak WS, Skotnicki AB. Szpiczak plazmocytowy. In: Podstawy hematologii. Medycyna Praktyczna, Kraków 2019: 354–372.
  3. Dimopoulos MA, Richardson PG, Moreau P, et al. Current treatment landscape for relapsed and/or refractory multiple myeloma. Nat Rev Clin Oncol. 2015; 12(1): 42–54.
  4. Naymagon L, Abdul-Hay M. Novel agents in the treatment of multiple myeloma: a review about the future. J Hematol Oncol. 2016; 9(1): 52.
  5. Giannopoulos K, Jamroziak K, Usnarska-Zubkiewicz L, et al. Zalecenia Polskiej Grupy Szpiczakowej dotyczące rozpoznawania i leczenia szpiczaka plazmocytowego oraz innych dyskrazji plazmocytowych na rok 2018/2019. Acta Haematol Pol. 2018; 49(4): 157–206.
  6. Celgene Corporation. POMALYST (pomalidomide) capsules, for oral use: US prescribing information. http://www.fda. gov (October 4, 2017).
  7. Zhu YX, Kortuem KM, Stewart AK. Molecular mechanism of action of immune-modulatory drugs thalidomide, lenalidomide and pomalidomide in multiple myeloma. Leuk Lymphoma. 2013; 54(4): 683–687.
  8. Lacy MQ, McCurdy AR. Pomalidomide. Blood. 2013; 122(14): 2305–2309.
  9. Richardson PG, Siegel DS, Vij R, et al. Pomalidomide alone or in combination with low-dose dexamethasone in relapsed and refractory multiple myeloma: a randomized phase 2 study. Blood. 2014; 123(12): 1826–1832.
  10. Miguel JS, Weisel K, Moreau P, et al. Pomalidomide plus low-dose dexamethasone versus high-dose dexamethasone alone for patients with relapsed and refractory multiple myeloma (MM-003): a randomised, open-label, phase 3 trial. The Lancet Oncol. 2013; 14(11): 1055–1066.
  11. Suska A, Czerniuk MR, Jurczyszyn A. Next-generation immunomodulatory drugs in multiple myeloma. Postepy Hig Med Dosw. 2019; 73: 791–802.
  12. Richardson PG, Oriol A, Beksac M, et al. OPTIMISMM trial investigators. Pomalidomide, bortezomib, and dexamethasone for patients with relapsed or refractory multiple myeloma previously treated with lenalidomide (OPTIMISMM): a randomised, open-label, phase 3 trial. Lancet Oncol. 2019; 20(6): 781–794.
  13. Siegel DS, Schiller GJ, Song KW, et al. Pomalidomide plus low-dose dexamethasone in relapsed refractory multiple myeloma after lenalidomide treatment failure. Br J Haematol. 2020; 188(4): 501–510.



Hematology in Clinical Practice