Carfilzomib-Lenalidomide-Dexamethasone in the Management of Lenalidomide-Refractory Multiple Myeloma

Abstract Carfilzomib is an epoxyketone proteasome inhibitor of second generation, proved to be effective and safe in relapsed refractory Multiple Myeloma (rrMM), combination with dexamethasone or lenalidomide dexamethasone. In this retrospective observational trial, it has been evaluated efficacy safety carfilzomib, lenalidomide-dexamethasone (KRD) as salvage regimen patients rrMM, lenalidomide, where lenalidomide-based regimens have no proven efficacy. 41 (23 M/18 F), median age at diagnosis 63.7 years (r. 43-82), start treatment 67 48-84) previously treated several lines treatments (median 3, r. 2-11), underwent KRD (ASPIRE trial schedule) for a cycles 8 (r 2-18). ISS was equally distributed, all had bortezomib IMIDs, were agents. 61% (19/31) them undergone least single ASCT. According IMWG criteria, after follow-up 9 months 2-18), ORR 68,2% (28/41: CR, 12 VGPR, 7 PR) 5 progressive diseases (PD) stable disease (SD): can considered impressive result subset rrMM patients, lenalidomide. particular, 11 was, having achieved PR, bridge second/third autologous SCT. Median time response 1.3 (r.1-4), OS from 62 9-170), well tolerated, grade 2 anemia 39%(16/41) successfully managed by ESAs, without necessity blood transfusions; 29% (12/41) 3-4 neutropenia (pegfilgrastim primary prophylaxis given, ospedalization required, septic shocks observed); 34% (14/41) 2, 21% (9/41) 3 12% (5/41) 4 thrombocytopenia, hemorrhagic events transfusion-dependency. Moreover, observed pneumonia 39% (16/41) common antibiotic drugs always solved. A cardiac monitoring performed patients: hypertension (grade 2-3) patients; fatigue (16/31) patients. Carfilzomib-Lenalidomide-Dexamethasone shown significant particularly severe setting available therapeutic resources, also could allogenic Disclosures Martinelli: Jazz Pharmaceuticals: Consultancy; Stemline Therapeutics: Astellas: Consultancy, Speakers Bureau; Celgene /BMS: Abbvie: Daichii Sankyo: Roche: Pfizer: Incyte: Consultancy.