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Bendamustine in combination with thalidomide and dexamethasone is a viable salvage option in myeloma relapsed and/or refractory to bortezomib and lenalidomide

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Abstract

Treatment options are limited in myeloma relapsed or refractory to both bortezomib and lenalidomide (double-relapsed/refractory multiple myeloma; DRMM). Bendamustine is an antitumour agent that has efficacy in relapsed myeloma. We retrospectively analysed data from 30 DRMM patients who received a combination of bendamustine, thalidomide and dexamethasone (BTD) in 28-day treatment cycles. Bendamustine was administered with a cumulative dose of up to 200 mg/m2. Thalidomide (50–150 mg) was given daily as tolerated, and dexamethasone was given at an equivalent dose of up to 160 mg per cycle. A median of 5 (2–9) treatment cycles were administered per patient. Twenty-six patients (87 %) achieved stable disease or better. At a median follow-up time of 12.1 (2.3–21.5) months, median (95 % CI) progression-free survival and overall survival were 4.0 (2.6–5.3) months and 7.2 (5.2–9.2) months, respectively. The most common grade 3–4 adverse events were haematological: anaemia (n = 8, 34.8 %), neutropenia (n = 16, 69.6 %) and thrombocytopenia (n = 10, 43.5 %). Non-haematological toxicities included pain (n = 3, 13.0 %), infection (n = 7, 30.4 %) and sensory neuropathy (n = 1, 4.3 %). We propose that BTD is a viable salvage treatment option for DRMM patients.

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Acknowledgments

The authors would like to thank Dr Joanna Todd (Napp Pharmaceuticals Limited) for medical writing support.

Author contributions

All authors performed the research. IL, DS, NR and KR designed the research study. IL and KR analysed the data. IL, AP, KY and KR wrote the paper.

Conflict of interest

Medical writing support was funded by Napp Pharmaceuticals Limited.

Dr. Lau has nothing to disclose.

Dr. Smith has nothing to disclose.

Dr. Aitchison has nothing to disclose.

Dr. Blesing has nothing to disclose.

Ms. Roberts has nothing to disclose.

Dr. Peniket has nothing to disclose.

Prof. Yong has nothing to disclose.

Dr. Rabin has nothing to disclose.

Dr. Ramasamy has nothing to disclose.

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Authors and Affiliations

  1. Level 2, Cancer and Hematology Centre, Churchill Hospital, Oxford University Hospitals NHS Trust, Oxford, OX3 7LE, UK

    I-Jun Lau, Pamela Roberts, Andrew Peniket & Karthik Ramasamy

  2. University College London NHS Foundation Trust, London, UK

    Dean Smith, Kwee Yong & Neil Rabin

  3. Buckinghamshire Hospitals NHS Trust, Amersham, UK

    Robin Aitchison

  4. Great Western Hospital, Swindon, UK

    Norbert Blesing

  5. Royal Berkshire NHS Foundation Trust, Reading, UK

    Karthik Ramasamy

  6. NIHR Biomedical Research Centre, Oxford, UK

    Karthik Ramasamy

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  1. I-Jun Lau
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Correspondence to I-Jun Lau.

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Lau, IJ., Smith, D., Aitchison, R. et al. Bendamustine in combination with thalidomide and dexamethasone is a viable salvage option in myeloma relapsed and/or refractory to bortezomib and lenalidomide. Ann Hematol 94, 643–649 (2015). https://doi.org/10.1007/s00277-014-2238-2

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  • DOI: https://doi.org/10.1007/s00277-014-2238-2

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