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. 2019 Jun 19;8(6):877.
doi: 10.3390/jcm8060877.

Feasibility, Tolerability and Efficacy of Carfilzomib in Combination with Lenalidomide and Dexamethasone in Relapsed Refractory Myeloma Patients: A Retrospective Real-Life Survey of the Sicilian Myeloma Network

Concetta Conticello  1 , Alessandra Romano  2 , Vittorio Del Fabro  3 , Enrica Antonia Martino  4 , Valeria Calafiore  5 , Giuseppe Sapienza  6 , Valerio Leotta  7 , Marina Silvia Parisi  8 , Uros Markovic  9 , Bruno Garibaldi  10 , Salvatore Leotta  11 , Emilia Cotzia  12 , Vanessa Innao  13 , Donato Mannina  14 , Santo Neri  15 , Maurizio Musso  16 , Renato Scalone  17 , Clotilde Cangialosi  18 , Francesco Acquaviva  19 , Giovanni Cardinale  20 , Anxur Merenda  21 , Cinzia Maugeri  22 , Giuseppina Uccello  23 , Massimo Poidomani  24 , Giuseppe Longo  25 , Melania Carlisi  26 , Daniele Tibullo  27 , Francesco Di Raimondo  28
Affiliations

Feasibility, Tolerability and Efficacy of Carfilzomib in Combination with Lenalidomide and Dexamethasone in Relapsed Refractory Myeloma Patients: A Retrospective Real-Life Survey of the Sicilian Myeloma Network

Concetta Conticello et al. J Clin Med. .

Abstract

Background: The ASPIRE (NCT01080391) phase 3 trial showed the efficacy of carfilzomib, lenalidomide and dexamethasone (KRd) triplet for relapse and refractory multiple myeloma (RRMM). However, little is known about safety and efficacy of KRd outside a clinical trial context. Methods: Herein we report real life results of KRd given to 130 RRMM patients from 12 Sicilian Centers. Results: Median age was 62 years; patients had received a median of two previous lines of treatment (range 1-10) and 52% were refractory to previous treatment. Median number of KRd cycles was 12 (2-29), with a mean duration of treatment of 12 months; 21 patients had received at least 18 cycles. Overall response rate was 61%, including 18% complete response. Median PFS was 22.9 months, median OS was not reached. Creatinine clearance >30 mL/min, quality of the best achieved response and standard Fluorescence In Situ Hybridization (FISH) risk were independent predictors of favorable outcome. Patients who received the full-dosage of carfilzomib in the first two cycles had a better outcome. Conclusions: KRd was effective and well tolerated and in a considerable proportion of patients, therapy continued beyond the 18th cycle. The finding of a better outcome in patients with the higher cumulative dose of carfilzomib in the first two cycle encourages to maintain the maximum tolerated dose.

Keywords: KRd regimen; multiple myeloma; salvage therapy.

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Conflict of interest statement

C.C., F.D.R., A.R., U.M. and V.L. received honoraria from Amgen. C.C., F.D.R. and A.R. received honoraria from Celgene. All the other authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Progression free survival (A) and overall survival (B) in 130 relapse and refractory multiple myeloma (RRMM) candidates to KRd as salvage regimen in a real-life approach.
Figure 2
Figure 2
Progression free survival and overall survival in 130 RRMM candidates to KRd as salvage regimen in a real-life approach. Progression free survival in 130 RRMM candidates to KRd as salvage regimen in a real-life approach based on response achieved (A), FISH risk (data available for only 64 patients) (B), and cumulative dose of carfilzomib received (C). Overall survival in 130 RRMM candidates to KRd as salvage regimen in a real-life approach based on response achieved (D), FISH risk (data available for only 64 patients) (E), and cumulative dose of carfilzomib received (F).
Figure 3
Figure 3
Progression free survival (A) and overall survival (B) based on previous exposure to lenalidomide in 130 RRMM candidates to KRd as salvage regimen in a real-life approach.
Figure 4
Figure 4
Progression free survival (A) and overall survival (B) based on creatinine clearance in 130 RRMM candidates to KRd as salvage regimen in a real-life approach.
See this image and copyright information in PMC

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