Multiple myeloma: mCBAD regimen viable for bridging in select patients

  • Tabchi S, et al.
  • Clin Lymphoma Myeloma Leuk
  • 7 May 2019

  • curated by David Reilly
  • Univadis Clinical Summaries
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Takeaway

  • In patients with myeloma, high-dose cyclophosphamide, bortezomib, doxorubicin, and dexamethasone (mCBAD) demonstrated high-level, but limited-duration, response.
  • Treatment-associated toxicities and treatment-related mortality limit applicability of the regimen to those bridging to transplantation or novel therapies in the absence of an alternative approach.

Why this matters

  • Refractory patients in this setting have limited treatment options in later stages.

Study design

  • Analysis of mCBAD in 140 patients with newly diagnosed multiple myeloma (NDMM), relapsed/refractory (R/R) MM, and plasma cell leukemia (PCL).
  • Funding: MD Anderson Cancer Center.  

Key results

  • Overall response rate:
    • R/R MM (n=116): 85% overall response rate (ORR); 7% complete remission (CR); 18% very good partial response (VGPR).
    • PCL (n=11): 100% ORR; 10% CR; 20% VGPR.
    • NDMM (n=13): 100% ORR; 23% CR; 23% VGPR.
  • Median PFS:
    • NDMM: 19.61 months (95% CI, 5.26-NA).
    • R/R MM: 4.64 (95% CI, 3.75-6.73) months.
    • PCL: 7.56 months (95% CI, 4.7-NA).
  • 11.48 (95% CI, 7.52-15.9) months median PFS in the 36.2% of patients who used mCBAD as a bridge to autologous hematopoietic stem cell transplantation (auto-HSCT) vs 3.19 (95% CI, 2.4-3.75) months in those who did not.
  • Treatment-related mortality:
    • NDMM: 0%.
    • R/R MM: 8%.
    • PCL: 9%.

Limitations

  • Retrospective data.