Prospective Study of DCEP Chemotherapy in Patients with Relapsed or Refractory Multiple Myeloma
Journal Title: Scholars Journal of Applied Medical Sciences - Year 2018, Vol 6, Issue 12
Abstract
Abstract: Multiple myeloma (MM) is the 2nd most common haematological malignancy among the elderly. Majority of MM patients develop refractoriness/relapse to conventional agents and in such patients, chemotherapy is one of the treatment options. However, prospective data on DCEP (dexamethasone, cyclophosphamide, etoposide, cisplatin) chemotherapy is limited. This phase II prospective study intends to find out the response rate, toxicity and survival outcomes of DCEP infusional chemotherapy in relapsed or refractory MM patients (RRMM) who failed ≥ 2 conventional lines of treatment (including bortezomib and one of the IMiDs). The study period was from January 2012 to December 2013. Twenty one patients were recruited into the study. The median age was 48 years (range 38-63y). Male:female ratio was 12:9. ISS stage I, II and III were equally distributed. Of the 21 patients, 15 completed 6 cycles of DCEP chemotherapy, 4 discontinued and 2 expired after 1st cycle (cause being pneumonia and dengue haemorrhagic fever). Eight (53.3%) had an overall response (complete, very good partial and partial response). The 2 yr and 5 yr progression free survival (PFS) was 10.5% and 5.3% respectively. The 2 yr and 5 yr overall survival (OS) was 46.4% and 37.2% respectively. At a median follow up of 29.1 months, the median PFS was 9.3 months [95% CI 5.2-13.4m] and the median OS was 21.4 months [95% CI 0-46.0m]. There were 5 grade 3/4 haematological toxicities which was managed with prophylactic growth factors and appropriate supportive care. At 5 yr follow up, 4 patients are alive, of whom 3 are on subsequent novel agents and one continues to be in remission. DCEP chemotherapy has good response rate with manageable toxicity and should be considered as a salvage option in RRMM patients. Molecular studies in RRMM are needed to find patients who may get durable benefit with infusional chemotherapy regimens.
Authors and Affiliations
Lakshmi Haridas K, Geetha Narayanan, Sreejith G Nair
Keywords
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