Use of KRD-PACE as Salvage Therapy in Aggressive, Relapsed/Bortezomib-Refractory Extramedullary Multiple Myeloma: A Report of Two Cases and Literature Review

Case Reports in Hematology
Ricardo D ParrondoSikander Ailawadhi

Abstract

Extramedullary multiple myeloma is defined by the presence of plasma cell infiltration outside of the bone marrow. It is associated with a poor prognosis and resistance to therapy and is often associated with high-risk cytogenetics. Aggressive relapsed and refractory extramedullary multiple myeloma is often treated with salvage infusional chemotherapy to achieve rapid disease control. Commonly used regimens include DCEP, CVAD, and VTD-PACE. While VTD-PACE contains bortezomib and thalidomide which have potent antimyeloma activity, the advent of novel agent therapy with proteasome inhibitors and immunomodulatory agents being used in the first-line setting has resulted in many patients being refractory to bortezomib by the time they are treated with VTD-PACE. Herein, we discuss two cases of aggressive relapsed, high-risk, bortezomib-refractory extramedullary multiple myeloma treated with KRD-PACE and review the available clinical data on salvage chemotherapy regimens used in relapsed refractory myeloma.

References

Jun 1, 1996·American Journal of Hematology·M A DimopoulosR Alexanian
Jul 16, 2003·Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology·Choon-Kee LeeGuido Tricot
Jun 27, 2007·British Journal of Haematology·Bart BarlogieJohn D Shaughnessy
Dec 6, 2012·Leukemia & Lymphoma·Matthew Weinstock, Irene M Ghobrial
Dec 3, 2014·The Lancet Oncology·S Vincent RajkumarJesus F San Miguel
Dec 9, 2014·The New England Journal of Medicine·A Keith StewartUNKNOWN ASPIRE Investigators
Oct 27, 2017·American Journal of Hematology·Arjun LakshmanShaji K Kumar

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Citations

Dec 2, 2020·Cancers·Titouan CazaubielAurore Perrot

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Methods Mentioned

BETA
biopsy
electrophoresis
surgical resection
flow cytometry

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