Pomalidomide and Low-Dose Dex may Benefit High-Risk del(17p) Multiple Myeloma Patients

Recent study results in Blood suggest that using pomalidomide and low-dose dexamethasone may benefit patients with certain high-risk features, particularly patients with del(17p). Pomalidomide is an immunomodulator (iMiD) approved in February 2013 by the FDA as a treatment for relapsed and refractory multiple myeloma and is now regularly used in treatment. From past clinical trials, the Intergroupe Francophone Myélome (IFM) made an observation that patients with high-risk cytogenetics (del 17p and translocation 4;14) had shorter progression free and overall survival than their peers, which was not a surprise based on the aggressive nature of these features. The IFM group wondered if these patients would benefit from pomalidomide and dexamethasone if used earlier in the relapse. They performed a study with patients from these two cytogenetic groups in 2012-2013. Patients were an average age of 63. They found a large difference in time to progression, the duration of response and overall response rate looking at the presence of del(17p) compared with the t(4;14). [columns ] [column size="1/3"]Measurement Total Time to Progression: Duration of Response: Overall Response Rate:[/column] [column size="1/3"]Del(17p) 7.3 months 8.3 months 32%[/column] [column size="1/3"]t(4;14) 2.8 months 2.4 months 15% [/column] [/columns] The reasons that this combination is potentially effective for del(17p) patients is unknown and the group plans more work on the subject. This study also provides further evidence that IMiD compounds share no cross-resistance, including pomalidomide following lenalidomide. Study authors believe that future work will use triple combinations of pomalidomide for high-risk myeloma patients, particularly in combination with a proteasome inhibitor, known for its synergy with IMiDs. To read the full article, click here.