Real-World Effectiveness and Safety Analysis of Carfilzomib-Pomalidomide- Dexamethasone in Relapsed/Refractory Multiple Myeloma: A Multicenter Retrospective Study from Eastern Shandong of China
Authors: Fan Huishou , Wei Rongxia , Feng Xiangyan , Zhang Xin , Li Tianlan , Liu Lu , Wang Hui , Sun Lingjie , Shi Xue , Zhao Hongguo , Li Zhao , Cui Jingying , Feng Xianqi , Xu Junqing , Ma Junjie , Qiu Lugui , Wang Wei 
Published: December 2024

Background:
Little is known about the real-world survival benefits and safety profiles of carfilzomib-pomalidomide-dexamethasone (KPd) in patients with relapsed and refractory multiple myeloma (RRMM).
Methods:
We performed a retrospective multicenter analysis to evaluate the efficacy and safety of KPd regimen in 81 patients with RRMM registered in the Eastern Shandong Myeloma Collaborative Group. All patients received at least 1cycle of KPd. KPd was performed in RRMM patients as follows: intravenous carfilzomib at a dose of 20mg/m2 on days 1 and 2, and then 27mg/m2 on days 8, 9, 15, and 16 of the first cycle and days 1, 2, 8, 9, 15, and 16 of subsequent cycles, dexamethasone 20 mg on days 1, 2, 8, 9, 15, 16, 22, and 23, and pomalidomide 4 mg orally on days 1-21 of each 28-day cycle.
Results:
The median age at the start of KPd regimen was 63 years old (range, 38-74),39 were male and 42 were female. Among 81 patients included, 22.2% of them have received upfront autologous hematopoietic stem cell transplantation. Before patients received KPd regimen, there were 39 (48.2%),25 (30.9%) and 17 (20.9%) patients have already received prior 1-line, 2-line, and ≥ 3-line treatment, respectively. 91.4% of patients previously exposed to bortezomib (45.7% refractory), 63.0% exposed to lenalidomide (35.8% refractory), and 32.1% exposed to anti-CD38 monoclonal antibody (16.1% refractory). 63.0% of patients exposed to both bortezomib and lenalidomide (25.9% double refractory), and 24.7% exposed to bortezomib, lenalidomide and CD38 antibody (3.7% triple refractory). There were 36(44.4%) and 31(38.3%) patients with ISS stage III and extramedullary disease, respectively. 30.9% of patients had prior history of high blood pressure and 21.0% of patients had a history of cardiovascular disease (coronary disease, heart failure, arrhythmia, etc.). The median duration of treatment was 3 months. Among 69 patients available for response assessment, the objective response rate (ORR) (≥partial response) was 66.5%(n=46) with 42.0% achieving ≥very good partial response and 31.9% achieving≥complete response. After a median follow-up of 6 months, he median progression-free survival (PFS) and overall survival (OS) were 12.7 months (95%CI: 6.83, Not estimable) and not reached (95% CI: 11.17, Not estimable), respectively. A total of 79 adverse events were observed in 33(40.7%) KPd cases and Grade I, Grade II and Grade III events were accounted for 36.7%(n=29),40.5% (n=32) and 22.8%(n=18), respectively. Grade III events were only observed in 12 patients and no higher events were observed. Infections(n=5), cardiovascular(n=5) and cytopenia(n=3) events were most frequent reported Grade III events, no patients died due to KPd related adverse events.
Conclusion:
KPd regimen showed considerable clinical benefits among RRMM in a real-world setting, and the adverse effects after KPd are controllable.