新型治疗时代复发/难治性骨髓瘤含蛋白酶体抑制剂联合方案的单日多药化疗方案

PCAB (prednisone, cyclophosphamide, doxorubicin, carmustine) is a single-day regimen previously used for induction and now in relapsed/refractory multiple myeloma (RRMM).

We retrospectively analysed the outcomes of 85 patients from five Australian centres. These included 30 patients (35. 3%) who received PCAB with one additional agent (bortezomib most frequently). Median age of the patients was 65 years (37-80), with a median of four (1-8) prior lines of therapy. ORR was 37% (CR 4. 9%). Median progression free survival and overall survival were 4. 4 months (95% CI 3. 5-6. 7) and 7. 4 months (95% CI 6. 4-10. 2), respectively. Extramedullary disease (EMD) was associated with shorter survival.

Grade 3 or 4 cytopenia and febrile neutropenia occurred in 76. 2% and 39. 1%, respectively, with six (7. 1%) treatment-related mortalities. Median inpatient stay was 3. 3 days/28-day cycle (IQR 0. 6-13), and for patients who died, a median of 20. 2% of days alive were spent inpatient (IQR 6. 4-39. 1%). Three patients were successfully bridged to CAR T-cell therapy using PCAB, despite being penta-exposed and having EMD. PCAB may be considered as a useful salvage therapy amongst other polychemotherapy regimens in late relapse.

Further studies is warranted to investigate and define its role as a bridging therapy to novel therapeutics.