Successful treatment with current pomalidomide-containing agents for secondary plasma cell leukemia

抄録

Plasma cell leukemia (PCL) is a rare and very aggressive form of plasma cell dyscrasia. In particular, secondary PCL (sPCL) shows poor prognosis and standard treatments remain lacking. We report herein two cases of patients with sPCL treated with elotuzumab, pomalidomide and dexamethasone (EPd) or isatuximab, pomalidomide and ­dexamethasone (IsaPd). After 2 cycles of IsaPd, stringent complete response (sCR) was seen in one patient, who is continuing to receive treatment while maintaining sCR. The other patient continued EPd for 8 cycles until progressive disease (PD) developed. Plasma cells in peripheral blood disappeared immediately, and best response was very good partial response. He was treated with 2 cycles of daratumumab, bortezomib and dexamethasone, then 3 cycles of IsaPd after PD again developed. These cases suggest that among the many novel agents that have been used against multiple myeloma, pomalidomide appears relatively effective for PCL. Further, administration of elotuzumab or isatuximab may provide additional effects to pomalidomide in the treatment of PCL. These therapies may represent effective options for the control of PCL, including sPCL, which has previously shown dismal prognosis.