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Original Article

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Blood Res 2016; 51(3):

Published online September 23, 2016

https://doi.org/10.5045/br.2016.51.3.193

© The Korean Society of Hematology

Bendamustine in heavily pre-treated multiple myeloma patients: Results of a retrospective analysis from the Korean Multiple Myeloma Working Party

Seok Jin Kim1, Soo-Mee Bang2, Yoon Seok Choi3, Deog-Yeon Jo3, Jin Seok Kim4, Hyewon Lee5, Hyeon Seok Eom5, Dok Hyun Yoon6, Cheolwon Suh6, Je-Jung Lee7, Junshik Hong8, Jae Hoon Lee8, Youngil Koh9, Kihyun Kim1, Sung-Soo Yoon9*, Chang-Ki Min10*, and Korean Multiple Myeloma Working Party

Author Info. +

1Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

2Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.

3Department of Internal Medicine, School of Medicine, Chungnam National University, Daejeon, Korea.

4Division of Hematology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.

5Hematology-Oncology Clinic, National Cancer Center, Goyang, Korea.

6Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

7Department of Hematology-Oncology, Chonnam National University Hwasun Hospital, Hwasun, Korea.

8Department of Internal Medicine, Gachon University School of Medicine, Incheon, Korea.

9Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.

10Division of Hematology, Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea.

Correspondence to : Correspondence to Sung-Soo Yoon, M.D., Ph.D. Division of Hematology/Oncology, Department of Internal Medicine, Cancer Research Institute, Seoul National University College of Medicine, Clinical Research Institute, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul 03080, Korea. ssysmc@snu.ac.kr

Received: May 20, 2016; Revised: June 6, 2016; Accepted: June 16, 2016

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

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Background

Bendamustine may be a potential treatment option for patients with myeloma, but little is known about the utility of bendamustine as a salvage treatment, especially in Asian patients.

Methods

We performed a multicenter retrospective study of patients with relapsed or refractory myeloma who received bendamustine and prednisone.

Results

The records of 65 heavily pre-treated patients, who had undergone bortezomib and lenalidomide treatment (median number of previous treatments: 5), were analyzed. The median time from diagnosis to bendamustine treatment was 3.8 years, and the median patient age was 63 years (range, 38‒77 yr). The responses to the last treatment before bendamustine were refractory disease (N=52, 80%) or disease progression from partial response (N=13, 20%). Twenty-three patients responded to the treatment, with an overall response rate of 35% (23/65), and the median number of bendamustine treatment cycles was two (range, 1‒5 cycles). The median overall survival after bendamustine treatment was 5.5 months and the overall survival rate in responders to bendamustine was significantly better than that in non-responders (P=0.036).

Conclusion

Bendamustine may be a potential salvage treatment to extend survival in a select group of heavily pre-treated patients with relapsed or refractory myeloma.

Keywords Myeloma, Bendamustine, Response, Toxicity, Survival

Article

Original Article

Blood Res 2016; 51(3): 193-199

Published online September 23, 2016 https://doi.org/10.5045/br.2016.51.3.193

Copyright © The Korean Society of Hematology.

Bendamustine in heavily pre-treated multiple myeloma patients: Results of a retrospective analysis from the Korean Multiple Myeloma Working Party

Seok Jin Kim1, Soo-Mee Bang2, Yoon Seok Choi3, Deog-Yeon Jo3, Jin Seok Kim4, Hyewon Lee5, Hyeon Seok Eom5, Dok Hyun Yoon6, Cheolwon Suh6, Je-Jung Lee7, Junshik Hong8, Jae Hoon Lee8, Youngil Koh9, Kihyun Kim1, Sung-Soo Yoon9*, Chang-Ki Min10*, and Korean Multiple Myeloma Working Party

1Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

2Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.

3Department of Internal Medicine, School of Medicine, Chungnam National University, Daejeon, Korea.

4Division of Hematology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.

5Hematology-Oncology Clinic, National Cancer Center, Goyang, Korea.

6Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

7Department of Hematology-Oncology, Chonnam National University Hwasun Hospital, Hwasun, Korea.

8Department of Internal Medicine, Gachon University School of Medicine, Incheon, Korea.

9Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.

10Division of Hematology, Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea.

Correspondence to:Correspondence to Sung-Soo Yoon, M.D., Ph.D. Division of Hematology/Oncology, Department of Internal Medicine, Cancer Research Institute, Seoul National University College of Medicine, Clinical Research Institute, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul 03080, Korea. ssysmc@snu.ac.kr

Received: May 20, 2016; Revised: June 6, 2016; Accepted: June 16, 2016

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background

Bendamustine may be a potential treatment option for patients with myeloma, but little is known about the utility of bendamustine as a salvage treatment, especially in Asian patients.

Methods

We performed a multicenter retrospective study of patients with relapsed or refractory myeloma who received bendamustine and prednisone.

Results

The records of 65 heavily pre-treated patients, who had undergone bortezomib and lenalidomide treatment (median number of previous treatments: 5), were analyzed. The median time from diagnosis to bendamustine treatment was 3.8 years, and the median patient age was 63 years (range, 38‒77 yr). The responses to the last treatment before bendamustine were refractory disease (N=52, 80%) or disease progression from partial response (N=13, 20%). Twenty-three patients responded to the treatment, with an overall response rate of 35% (23/65), and the median number of bendamustine treatment cycles was two (range, 1‒5 cycles). The median overall survival after bendamustine treatment was 5.5 months and the overall survival rate in responders to bendamustine was significantly better than that in non-responders (P=0.036).

Conclusion

Bendamustine may be a potential salvage treatment to extend survival in a select group of heavily pre-treated patients with relapsed or refractory myeloma.

Keywords: Myeloma, Bendamustine, Response, Toxicity, Survival

Fig 1.

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Figure 1.

(A, B) Median overall survival (OS) and progression-free survival (PFS) after bendamustine treatment was 5.5 months (95% confidence interval [CI], 3.5–7.5 mo) and 3.1 months (95% CI, 2.4–3.8 mo), respectively.

Blood Research 2016; 51: 193-199https://doi.org/10.5045/br.2016.51.3.193

Fig 2.

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Figure 2.

(A) The OS of patients who responded to bendamustine was significantly better than that of patients who did not. (B) Performance status at the time of bendamustine treatment was significantly associated with OS. (C) Patients ≤60 years old at the time of bendamustine treatment showed a trend towards better OS. (D) The median number of lines prior to bendamustine treatment was not associated with OS.

Blood Research 2016; 51: 193-199https://doi.org/10.5045/br.2016.51.3.193
Clinical and laboratory characteristics of the patients.

Abbreviations: ASCT, autologous stem cell transplantation; BAD, bortezomib, doxorubicin, dexamethasone; BD, bortezomib, dexamethasone; BMP, bortezomib, melphalan, prednisolone; CD, cyclophosphamide, dexamethasone; DS, Durie-Salmon; ECOG, Eastern Cooperative Oncology Group; ISS, International Staging System; LD, lenalidomide, dexamethasone; LDH, lactate dehydrogenase; MP, melphalan, prednisolone; MPT, melphalan, prednisolone, thalidomide; PS, performance status; TD, thalidomide, dexamethasone; TCD, thalidomide, cyclophosphamide, dexamethasone; SCT, stem cell transplantation; VAD, vincristine, doxorubicin, dexamethasone..
Toxicity profiles.
Comparisons between multicenter studies of bendamustine treatment for relapsed or refractory myeloma.

a)This study just described the percentage of patients exposed to immunomodulatory drugs. b)The ORR of the study included the response rates of different regimens. c)The hematologic toxicity was based on grade 3/4 anemia. d)The hematologic toxicity was based on grade 3/4 neutropenia..

Abbreviations: G, grade; OS, overall survival; PR, partial response; SCT, stem cell transplantation..
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