Abstract
A number of salvage high-intensity chemotherapy options have been designed to rapidly control progressive multiple myeloma (MM). We report our experience with vincristine, BNCU [carmustine], cyclophosphamide, and prednisone (VBCP), a regimen given in the outpatient setting to patients with relapsed/refractory MM (RRMM) resistant to almost all the available novel and targeted therapies. The VBCP regimen includes V 1.2 mg/m2 (max 2.0 mg) IV d1, B 20 mg/m2 IV d1, C 400 mg/m2 IV d1-4, and P 40 mg/m2 d1-7, given every 28-35 days with growth factor support. Ten patients were identified who were treated with VBCP from January 2013 to August 2016 at the University of Florida. The median age at diagnosis of MM was 63 (range, 51-73). Seventy percent had IgG kappa, 10% had IgA kappa, and 20% had kappa-only disease. These patients were heavily pretreated with a median of 5.5 prior treatment regimens (range, 4-11) including lenalidomide, pomalidomide, bortezomib, carfilzomib, cyclophosphamide, and autologous stem cell transplantation (Table 1). The objective response rate (≥ partial response) was 60% with an additional 30% achieving minimal response or stable disease. The median time to progression for patients with stable disease or better was 5.2 months. The median progression free survival was 4.4 months while the median overall survival was 12.8 months. Treatment related toxicities were mainly grade ≥ 3 anemia, thrombocytopenia, and neutropenia observed in 50%, 60%, and 60% of patients, respectively. Neutropenic fever was observed in 20% of patients. Other non-hematologic complications included tumor lysis, neuropathy, GI symptoms, localized skin and lung infections, and atrial fibrillation. Despite the above toxicities, 61% of the subsequent cycles were given on time within 28-35 days. No treatment-related mortality was observed. Our results suggest VBCP may be a highly active and tolerable salvage regimen with impressive response rate among heavily pre-treated patients with RRMM who already failed many of the novel agents.
No relevant conflicts of interest to declare.
This feature is available to Subscribers Only
Sign In or Create an Account Close Modal