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Bendamustine and prednisone in combination with bortezomib (BPV) in the treatment of patients with relapsed or refractory multiple myeloma and light chain-induced renal failure

: Pönisch, Wolfram; Moll, Barbara; Bourgeois, Malvina; Andrea, Marc; Schliwa, Thomas; Heyn, Simone; Schmalfeld, Marion; Edelmann, Thomas; Becker, Cornelia; Hoffmann, Franz Albert; Schwarzer, Andreas; Kreibich, Ute; Egert, Matthias; Stiegler, Runa; Krahl, Rainer; Remane, Yvonne; Bachmann, Anette; Lindner, Tom; Weidhase, Lorenz; Petros, Sirak; Fricke, Stephan; Vucinic, Vladan; Al-Ali, Haifa Kathrin; Niederwieser, Dietger


Journal of cancer research and clinical oncology 139 (2013), Nr.11, S.1937-1946
ISSN: 0171-5216 (Print)
ISSN: 0084-5353
ISSN: 0943-9382
ISSN: 1432-1335 (Online)
Fraunhofer IZI ()
relapsed/refractory multiple myeloma; advanced renal failure; bendamustine; bortezomib; prednisone

Serious renal failure represents a severe complication of multiple myeloma (MM), with an estimated 25–50 % of patients being affected. Both bortezomib and bendamustine have been identified as quickly acting, effective and well-tolerated drugs and might therefore constitute an adequate combination regimen for patients presenting with light chain-induced renal failure.
Between March 2005 and March 2013, 36 patients with relapsed/refractory MM and light chain-induced renal failure (creatinine clearance <60 ml/min) were treated with bendamustine 60 mg/m2 on days 1 and 2, bortezomib 1.3 mg/m2 on days 1, 4, 8 and 11 and prednisone 100 mg on days 1, 2, 4, 8 and 11 (BPV). Patients were divided according to severity of renal impairment into group A (n = 20) with moderate or severe renal dysfunction (eGFR 15–59 ml/min) and group B (n = 16) with renal failure/dialysis (eGFR <15 ml/min).
Twenty-four patients (67 %) responded with three CR, three nCR, six VGPR and 12 PR. Six patients had minor response, two stable and four progressive disease. With a median follow-up period of 22 months, median progression-free survival (PFS) and overall survival (OS) for patients of group A were 10 and 25 months, respectively. This outcome was significantly better compared to patients of group B with a median PFS and OS of 3 and 7 months, respectively. Eleven patients showed a CRrenal, five a PRrenal and 15 a MRrenal.
These results indicate that this BPV combination is feasible, effective and well tolerated in patients with relapsed/refractory MM and light chain-induced renal failure.