Successful salvage therapy of D-PACE combined with pomalidomide in a patient with triple-class refractory secondary plasma cell leukemia

抄録

Novel agents have dramatically improved the prognosis of multiple myeloma (MM). However, the prognosis of MM resistant to several classes of novel agents and secondary plasma cell leukemia (sPCL) is poor. In such cases, cisplatin, doxorubicin, cyclophosphamide, and etoposide (PACE)-based regimens are considered in combination with dexamethasone, thalidomide, and bortezomib. Herein, we report the case of a 47-year-old patient with Bence Jones Protein (BJP)-λ-type MM, primary refractory to bortezomib, lenalidomide, and dexamethasone (VRd) therapy, which subsequently progressed to sPCL accompanied with the acquired 17p deletion. Although the patient was also refractory to daratumumab-based therapy (triple-class refractory MM), he was successfully treated with dexamethasone and pomalidomide with PACE (DP-PACE) therapy, and after three cycles, he achieved complete remission (CR) and bridged to allogeneic stem cell transplantation (SCT). To the best of our knowledge, this is the first report of DP-PACE regimen, which may be considered for patients with relapsed refractory MM as a bridge to SCT.