内容紹介
Effective BiRd Therapy after the Addition of Clarithromycin for Lenalidomide and Dexamethasone Resistant Multiple Myeloma Ineligible for Stem Cell Transplantation
Summary
BiRd combination therapy, which comprises clarithromycin(CAM: Biaxin®), lenalidomide(LEN: Revlimid®), and dexamethasone(DEX), is a highly effective treatment for newly diagnosed symptomatic multiple myeloma(MM). However, its efficacy against recurrent myeloma refractory to LEN and DEX combination therapy(Rd therapy)remains unclear. In this study, we retrospectively analyzed the data of 7 patients(4 men and 3 women, median age of 76 years)with MM, who had clarithromycin added to their Rd regimen. In all patients, the starting dose of clarithromycin was 400 mg daily and the median number of prior therapies was 3(range, 1-4). Patients received a median of 9 cycles of Rd(range, 6-27 cycles)for a median duration of 8 months. Then, patients received a median of 14 cycles of BiRd(range 2-36 cycles). One patient showed partial response(PR), which was the best response, while the others showed stable disease(SD). Our results demonstrated that the addition of clarithromycin to Rd could overcome resistance to Rd and lead to durable responses, without exacerbating hematological or non-hematological toxicities. Thus, BiRd therapy may represent a therapeutic option for symptomatic MM resistant to Rd therapy.
要旨
BiRdはclarithromycin(CAM: Biaxin®)・lenalidomide(LEN: Revlimid®)・dexamethasone(DEX)の併用療法であるが,LEN・DEX(Rd)療法に抵抗性となった骨髄腫におけるBiRd療法の有効性は明らかにされていない。当院でRd療法に抵抗性となった移植非適応骨髄腫7例(男性4例・女性3例,年齢中央値76歳)に対して,当院倫理委員会の承認を経て患者の同意の下,CAM 400 mg/dayを上乗せした。前治療レジメン中央値は3(1～4)で,CAM追加以前のRd療法中央値は9(6～27)サイクル(治療期間中央値8か月)であった。BiRd療法の中央値は14(2～36)サイクル(治療期間中央値13.1か月),最大治療効果はPR 1例,SD 6例であり,全例でCAMの上乗せにより病勢の進行が制御された。CAMの上乗せによる重篤な有害事象はなかった。Rd抵抗性移植非適応骨髄腫患者へのBiRd療法の切り替えは治療選択肢となると考えられた。
目次
Summary
BiRd combination therapy, which comprises clarithromycin(CAM: Biaxin®), lenalidomide(LEN: Revlimid®), and dexamethasone(DEX), is a highly effective treatment for newly diagnosed symptomatic multiple myeloma(MM). However, its efficacy against recurrent myeloma refractory to LEN and DEX combination therapy(Rd therapy)remains unclear. In this study, we retrospectively analyzed the data of 7 patients(4 men and 3 women, median age of 76 years)with MM, who had clarithromycin added to their Rd regimen. In all patients, the starting dose of clarithromycin was 400 mg daily and the median number of prior therapies was 3(range, 1-4). Patients received a median of 9 cycles of Rd(range, 6-27 cycles)for a median duration of 8 months. Then, patients received a median of 14 cycles of BiRd(range 2-36 cycles). One patient showed partial response(PR), which was the best response, while the others showed stable disease(SD). Our results demonstrated that the addition of clarithromycin to Rd could overcome resistance to Rd and lead to durable responses, without exacerbating hematological or non-hematological toxicities. Thus, BiRd therapy may represent a therapeutic option for symptomatic MM resistant to Rd therapy.
要旨
BiRdはclarithromycin(CAM: Biaxin®)・lenalidomide(LEN: Revlimid®)・dexamethasone(DEX)の併用療法であるが,LEN・DEX(Rd)療法に抵抗性となった骨髄腫におけるBiRd療法の有効性は明らかにされていない。当院でRd療法に抵抗性となった移植非適応骨髄腫7例(男性4例・女性3例,年齢中央値76歳)に対して,当院倫理委員会の承認を経て患者の同意の下,CAM 400 mg/dayを上乗せした。前治療レジメン中央値は3(1～4)で,CAM追加以前のRd療法中央値は9(6～27)サイクル(治療期間中央値8か月)であった。BiRd療法の中央値は14(2～36)サイクル(治療期間中央値13.1か月),最大治療効果はPR 1例,SD 6例であり,全例でCAMの上乗せにより病勢の進行が制御された。CAMの上乗せによる重篤な有害事象はなかった。Rd抵抗性移植非適応骨髄腫患者へのBiRd療法の切り替えは治療選択肢となると考えられた。