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04.03.2020 | Original Article

DCEP and bendamustine/prednisone as salvage therapy for quad- and penta-refractory multiple myeloma

verfasst von: Scott R. Goldsmith, Mark A. Fiala, Brandon Wang, Mark A. Schroeder, Tanya M. Wildes, Armin Ghobadi, Keith Stockerl-Goldstein, Ravi Vij

Erschienen in: Annals of Hematology | Ausgabe 5/2020

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Abstract

Multiple myeloma (MM) almost invariably progresses through novel therapies. Patients with quad-refractory MM (refractory to bortezomib, carfilzomib, lenalidomide, and pomalidomide) and penta-refractory MM (additional refractoriness to daratumumab) have few treatment options. Two chemotherapy regimens, bendamustine/prednisone (BP) and dexamethasone, cyclophosphamide, etoposide, and cisplatin (DCEP), are often used in quad- and penta-refractory MM, but there are limited data on outcomes in this heavily pre-treated population. We conducted a single-center retrospective study to identify all patients who received DCEP and/or BP for quad- or penta-refractory MM. Disease response and refractoriness were defined by International Myeloma Working Group criteria. The primary endpoint was overall response rate (ORR). Secondary endpoints included overall survival (OS), progression-free survival (PFS), and duration of response (DOR). We identified 27 patients who received BP for quad- or penta-refractory MM. The median number of prior lines of therapy was 6. The ORR for BP was 26%. The median PFS for BP was 1.4 months (95% CI 1.1–1.6) and median OS was 8.7 months (95% CI 2.3–15.0). Patients treated with cyclophosphamide had less response to BP. Thirty-one patients received DCEP for quad-refractory or penta-refractory MM. The median number of prior treatment regimens was 8. The ORR to DCEP was 35%. The median PFS was 2.7 months (95% CI 1.5–3.8) and median OS was 6.2 months (95% CI 4.4–7.8). DCEP and BP retain efficacy in quad- and penta-refractory MM. Our analysis supports prospective study of these regimens, possibly in combination or in comparison with other agents in this area of unmet need.
Literatur
2.
Zurück zum Zitat Radocha J, Maisnar V, Pour L et al (2016) Multiple myeloma R-ISS prognostic stratification system in real life population. Blood 128:3333 LP–3333333CrossRef Radocha J, Maisnar V, Pour L et al (2016) Multiple myeloma R-ISS prognostic stratification system in real life population. Blood 128:3333 LP–3333333CrossRef
3.
Zurück zum Zitat Ledergor G, Weiner A, Zada M, Wang SY, Cohen YC, Gatt ME, Snir N, Magen H, Koren-Michowitz M, Herzog-Tzarfati K, Keren-Shaul H, Bornstein C, Rotkopf R, Yofe I, David E, Yellapantula V, Kay S, Salai M, Ben Yehuda D, Nagler A, Shvidel L, Orr-Urtreger A, Halpern KB, Itzkovitz S, Landgren O, San-Miguel J, Paiva B, Keats JJ, Papaemmanuil E, Avivi I, Barbash GI, Tanay A, Amit I (2018) Single cell dissection of plasma cell heterogeneity in symptomatic and asymptomatic myeloma. Nat Med 24:1867–1876. https://doi.org/10.1038/s41591-018-0269-2 CrossRefPubMed Ledergor G, Weiner A, Zada M, Wang SY, Cohen YC, Gatt ME, Snir N, Magen H, Koren-Michowitz M, Herzog-Tzarfati K, Keren-Shaul H, Bornstein C, Rotkopf R, Yofe I, David E, Yellapantula V, Kay S, Salai M, Ben Yehuda D, Nagler A, Shvidel L, Orr-Urtreger A, Halpern KB, Itzkovitz S, Landgren O, San-Miguel J, Paiva B, Keats JJ, Papaemmanuil E, Avivi I, Barbash GI, Tanay A, Amit I (2018) Single cell dissection of plasma cell heterogeneity in symptomatic and asymptomatic myeloma. Nat Med 24:1867–1876. https://​doi.​org/​10.​1038/​s41591-018-0269-2 CrossRefPubMed
6.
Zurück zum Zitat Merz M, Jauch A, Hielscher T, Bochtler T, Schönland SO, Seckinger A, Hose D, Bertsch U, Neben K, Raab MS, Hillengass J, Salwender H, Blau IW, Lindemann HW, Schmidt-Wolf IGH, Scheid C, Haenel M, Weisel KC, Goldschmidt H (2018) Prognostic significance of cytogenetic heterogeneity in patients with newly diagnosed multiple myeloma. Blood Adv 2:1–9. https://doi.org/10.1182/bloodadvances.2017013334 CrossRefPubMed Merz M, Jauch A, Hielscher T, Bochtler T, Schönland SO, Seckinger A, Hose D, Bertsch U, Neben K, Raab MS, Hillengass J, Salwender H, Blau IW, Lindemann HW, Schmidt-Wolf IGH, Scheid C, Haenel M, Weisel KC, Goldschmidt H (2018) Prognostic significance of cytogenetic heterogeneity in patients with newly diagnosed multiple myeloma. Blood Adv 2:1–9. https://​doi.​org/​10.​1182/​bloodadvances.​2017013334 CrossRefPubMed
7.
Zurück zum Zitat Christofferson A, Nasser S, Aldrich J et al (2017) Integrative analysis of the genomic landscape underlying multiple myeloma at diagnosis: an Mmrf Commpass analysis. Blood 130:326 LP–326326 Christofferson A, Nasser S, Aldrich J et al (2017) Integrative analysis of the genomic landscape underlying multiple myeloma at diagnosis: an Mmrf Commpass analysis. Blood 130:326 LP–326326
9.
Zurück zum Zitat Sonneveld P, Avet-Loiseau H, Lonial S, Usmani S, Siegel D, Anderson KC, Chng WJ, Moreau P, Attal M, Kyle RA, Caers J, Hillengass J, San Miguel J, van de Donk N, Einsele H, Bladé J, Durie BG, Goldschmidt H, Mateos MV, Palumbo A, Orlowski R (2016) Treatment of multiple myeloma with high-risk cytogenetics: a consensus of the International Myeloma Working Group. Blood 127:2955–2962. https://doi.org/10.1182/blood-2016-01-631200 CrossRefPubMedPubMedCentral Sonneveld P, Avet-Loiseau H, Lonial S, Usmani S, Siegel D, Anderson KC, Chng WJ, Moreau P, Attal M, Kyle RA, Caers J, Hillengass J, San Miguel J, van de Donk N, Einsele H, Bladé J, Durie BG, Goldschmidt H, Mateos MV, Palumbo A, Orlowski R (2016) Treatment of multiple myeloma with high-risk cytogenetics: a consensus of the International Myeloma Working Group. Blood 127:2955–2962. https://​doi.​org/​10.​1182/​blood-2016-01-631200 CrossRefPubMedPubMedCentral
12.
Zurück zum Zitat Attal M, Harousseau JL (1997) Standard therapy versus autologous transplantation in multiple myeloma. Hematol Oncol Clin North Am 11:133–146CrossRefPubMed Attal M, Harousseau JL (1997) Standard therapy versus autologous transplantation in multiple myeloma. Hematol Oncol Clin North Am 11:133–146CrossRefPubMed
15.
Zurück zum Zitat Stewart AK, Rajkumar SV, Dimopoulos MA, Masszi T, Špička I, Oriol A, Hájek R, Rosiñol L, Siegel DS, Mihaylov GG, Goranova-Marinova V, Rajnics P, Suvorov A, Niesvizky R, Jakubowiak AJ, San-Miguel JF, Ludwig H, Wang M, Maisnar V, Minarik J, Bensinger WI, Mateos MV, Ben-Yehuda D, Kukreti V, Zojwalla N, Tonda ME, Yang X, Xing B, Moreau P, Palumbo A, ASPIRE Investigators (2015) Carfilzomib, lenalidomide, and dexamethasone for relapsed multiple myeloma. N Engl J Med 372:142–152. https://doi.org/10.1056/NEJMoa1411321 CrossRefPubMed Stewart AK, Rajkumar SV, Dimopoulos MA, Masszi T, Špička I, Oriol A, Hájek R, Rosiñol L, Siegel DS, Mihaylov GG, Goranova-Marinova V, Rajnics P, Suvorov A, Niesvizky R, Jakubowiak AJ, San-Miguel JF, Ludwig H, Wang M, Maisnar V, Minarik J, Bensinger WI, Mateos MV, Ben-Yehuda D, Kukreti V, Zojwalla N, Tonda ME, Yang X, Xing B, Moreau P, Palumbo A, ASPIRE Investigators (2015) Carfilzomib, lenalidomide, and dexamethasone for relapsed multiple myeloma. N Engl J Med 372:142–152. https://​doi.​org/​10.​1056/​NEJMoa1411321 CrossRefPubMed
18.
Zurück zum Zitat Lokhorst HM, Plesner T, Laubach JP, Nahi H, Gimsing P, Hansson M, Minnema MC, Lassen U, Krejcik J, Palumbo A, van de Donk N, Ahmadi T, Khan I, Uhlar CM, Wang J, Sasser AK, Losic N, Lisby S, Basse L, Brun N, Richardson PG (2015) Targeting CD38 with daratumumab monotherapy in multiple myeloma. N Engl J Med 373:1207–1219. https://doi.org/10.1056/NEJMoa1506348 CrossRefPubMed Lokhorst HM, Plesner T, Laubach JP, Nahi H, Gimsing P, Hansson M, Minnema MC, Lassen U, Krejcik J, Palumbo A, van de Donk N, Ahmadi T, Khan I, Uhlar CM, Wang J, Sasser AK, Losic N, Lisby S, Basse L, Brun N, Richardson PG (2015) Targeting CD38 with daratumumab monotherapy in multiple myeloma. N Engl J Med 373:1207–1219. https://​doi.​org/​10.​1056/​NEJMoa1506348 CrossRefPubMed
19.
Zurück zum Zitat Palumbo A, Chanan-Khan A, Weisel K, Nooka AK, Masszi T, Beksac M, Spicka I, Hungria V, Munder M, Mateos MV, Mark TM, Qi M, Schecter J, Amin H, Qin X, Deraedt W, Ahmadi T, Spencer A, Sonneveld P, CASTOR Investigators (2016) Daratumumab, bortezomib, and dexamethasone for multiple myeloma. N Engl J Med 375:754–766. https://doi.org/10.1056/NEJMoa1606038 CrossRefPubMed Palumbo A, Chanan-Khan A, Weisel K, Nooka AK, Masszi T, Beksac M, Spicka I, Hungria V, Munder M, Mateos MV, Mark TM, Qi M, Schecter J, Amin H, Qin X, Deraedt W, Ahmadi T, Spencer A, Sonneveld P, CASTOR Investigators (2016) Daratumumab, bortezomib, and dexamethasone for multiple myeloma. N Engl J Med 375:754–766. https://​doi.​org/​10.​1056/​NEJMoa1606038 CrossRefPubMed
20.
Zurück zum Zitat Dimopoulos MA, Oriol A, Nahi H, San-Miguel J, Bahlis NJ, Usmani SZ, Rabin N, Orlowski RZ, Komarnicki M, Suzuki K, Plesner T, Yoon SS, Ben Yehuda D, Richardson PG, Goldschmidt H, Reece D, Lisby S, Khokhar NZ, O’Rourke L, Chiu C, Qin X, Guckert M, Ahmadi T, Moreau P, POLLUX Investigators (2016) Daratumumab, lenalidomide, and dexamethasone for multiple myeloma. N Engl J Med 375:1319–1331. https://doi.org/10.1056/NEJMoa1607751 CrossRefPubMed Dimopoulos MA, Oriol A, Nahi H, San-Miguel J, Bahlis NJ, Usmani SZ, Rabin N, Orlowski RZ, Komarnicki M, Suzuki K, Plesner T, Yoon SS, Ben Yehuda D, Richardson PG, Goldschmidt H, Reece D, Lisby S, Khokhar NZ, O’Rourke L, Chiu C, Qin X, Guckert M, Ahmadi T, Moreau P, POLLUX Investigators (2016) Daratumumab, lenalidomide, and dexamethasone for multiple myeloma. N Engl J Med 375:1319–1331. https://​doi.​org/​10.​1056/​NEJMoa1607751 CrossRefPubMed
22.
Zurück zum Zitat Vogl DT, Dingli D, Cornell RF et al (2016) Selinexor and low dose dexamethasone (Sd) in patients with lenalidomide, pomalidomide, bortezomib, carfilzomib and anti-CD38 Ab refractory multiple myeloma (MM): STORM study. Blood 128:491 LP–491491CrossRef Vogl DT, Dingli D, Cornell RF et al (2016) Selinexor and low dose dexamethasone (Sd) in patients with lenalidomide, pomalidomide, bortezomib, carfilzomib and anti-CD38 Ab refractory multiple myeloma (MM): STORM study. Blood 128:491 LP–491491CrossRef
24.
Zurück zum Zitat Gandhi UH, Cornell RF, Lakshman A, Gahvari ZJ, McGehee E, Jagosky MH, Gupta R, Varnado W, Fiala MA, Chhabra S, Malek E, Mansour J, Paul B, Barnstead A, Kodali S, Neppalli A, Liedtke M, Narayana S, Godby KN, Kang Y, Kansagra A, Umyarova E, Scott EC, Hari P, Vij R, Usmani SZ, Callander NS, Kumar SK, Costa LJ (2019) Outcomes of patients with multiple myeloma refractory to CD38-targeted monoclonal antibody therapy. Leukemia. 33:2266–2275. https://doi.org/10.1038/s41375-019-0435-7 CrossRefPubMedPubMedCentral Gandhi UH, Cornell RF, Lakshman A, Gahvari ZJ, McGehee E, Jagosky MH, Gupta R, Varnado W, Fiala MA, Chhabra S, Malek E, Mansour J, Paul B, Barnstead A, Kodali S, Neppalli A, Liedtke M, Narayana S, Godby KN, Kang Y, Kansagra A, Umyarova E, Scott EC, Hari P, Vij R, Usmani SZ, Callander NS, Kumar SK, Costa LJ (2019) Outcomes of patients with multiple myeloma refractory to CD38-targeted monoclonal antibody therapy. Leukemia. 33:2266–2275. https://​doi.​org/​10.​1038/​s41375-019-0435-7 CrossRefPubMedPubMedCentral
25.
Zurück zum Zitat Vogl DT, Dingli D, Cornell RF, Huff CA, Jagannath S, Bhutani D, Zonder J, Baz R, Nooka A, Richter J, Cole C, Vij R, Jakubowiak A, Abonour R, Schiller G, Parker TL, Costa LJ, Kaminetzky D, Hoffman JE, Yee AJ, Chari A, Siegel D, Fonseca R, van Wier S, Ahmann G, Lopez I, Kauffman M, Shacham S, Saint-Martin JR, Picklesimer CD, Choe-Juliak C, Stewart AK (2018) Selective inhibition of nuclear export with oral selinexor for treatment of relapsed or refractory multiple myeloma. J Clin Oncol 36:859–866. https://doi.org/10.1200/JCO.2017.75.5207 CrossRefPubMedPubMedCentral Vogl DT, Dingli D, Cornell RF, Huff CA, Jagannath S, Bhutani D, Zonder J, Baz R, Nooka A, Richter J, Cole C, Vij R, Jakubowiak A, Abonour R, Schiller G, Parker TL, Costa LJ, Kaminetzky D, Hoffman JE, Yee AJ, Chari A, Siegel D, Fonseca R, van Wier S, Ahmann G, Lopez I, Kauffman M, Shacham S, Saint-Martin JR, Picklesimer CD, Choe-Juliak C, Stewart AK (2018) Selective inhibition of nuclear export with oral selinexor for treatment of relapsed or refractory multiple myeloma. J Clin Oncol 36:859–866. https://​doi.​org/​10.​1200/​JCO.​2017.​75.​5207 CrossRefPubMedPubMedCentral
27.
Zurück zum Zitat Zhao W-H, Liu J, Wang B-Y, Chen YX, Cao XM, Yang Y, Zhang YL, Wang FX, Zhang PY, Lei B, Gu LF, Wang JL, Yang N, Zhang R, Zhang H, Shen Y, Bai J, Xu Y, Wang XG, Zhang RL, Wei LL, Li ZF, Li ZZ, Geng Y, He Q, Zhuang QC, Fan XH, He AL, Zhang WG (2018) A phase 1, open-label study of LCAR-B38M, a chimeric antigen receptor T cell therapy directed against B cell maturation antigen, in patients with relapsed or refractory multiple myeloma. J Hematol Oncol 11:141. https://doi.org/10.1186/s13045-018-0681-6 CrossRefPubMedPubMedCentral Zhao W-H, Liu J, Wang B-Y, Chen YX, Cao XM, Yang Y, Zhang YL, Wang FX, Zhang PY, Lei B, Gu LF, Wang JL, Yang N, Zhang R, Zhang H, Shen Y, Bai J, Xu Y, Wang XG, Zhang RL, Wei LL, Li ZF, Li ZZ, Geng Y, He Q, Zhuang QC, Fan XH, He AL, Zhang WG (2018) A phase 1, open-label study of LCAR-B38M, a chimeric antigen receptor T cell therapy directed against B cell maturation antigen, in patients with relapsed or refractory multiple myeloma. J Hematol Oncol 11:141. https://​doi.​org/​10.​1186/​s13045-018-0681-6 CrossRefPubMedPubMedCentral
30.
Zurück zum Zitat Pönisch W, Mitrou PS, Merkle K, Herold M, Assmann M, Wilhelm G, Dachselt K, Richter P, Schirmer V, Schulze A, Subert R, Harksel B, Grobe N, Stelzer E, Schulze M, Bittrich A, Freund M, Pasold R, Friedrich T, Helbig W, Niederwieser D, East German Study Group of Hematology and Oncology (OSHO) (2006) Treatment of bendamustine and prednisone in patients with newly diagnosed multiple myeloma results in superior complete response rate, prolonged time to treatment failure and improved quality of life compared to treatment with melphalan and prednisone--a randomized phase III study of the East German Study Group of Hematology and Oncology (OSHO). J Cancer Res Clin Oncol 132:205–212. https://doi.org/10.1007/s00432-005-0074-4 CrossRefPubMed Pönisch W, Mitrou PS, Merkle K, Herold M, Assmann M, Wilhelm G, Dachselt K, Richter P, Schirmer V, Schulze A, Subert R, Harksel B, Grobe N, Stelzer E, Schulze M, Bittrich A, Freund M, Pasold R, Friedrich T, Helbig W, Niederwieser D, East German Study Group of Hematology and Oncology (OSHO) (2006) Treatment of bendamustine and prednisone in patients with newly diagnosed multiple myeloma results in superior complete response rate, prolonged time to treatment failure and improved quality of life compared to treatment with melphalan and prednisone--a randomized phase III study of the East German Study Group of Hematology and Oncology (OSHO). J Cancer Res Clin Oncol 132:205–212. https://​doi.​org/​10.​1007/​s00432-005-0074-4 CrossRefPubMed
33.
Zurück zum Zitat Knop S, Straka C, Haen M (2005) The efficacy and toxicity of bendamustine in recurrent multiple myeloma after high-dose chemotherapy. Haematologica 90:1287–1288PubMed Knop S, Straka C, Haen M (2005) The efficacy and toxicity of bendamustine in recurrent multiple myeloma after high-dose chemotherapy. Haematologica 90:1287–1288PubMed
35.
Zurück zum Zitat Anderson KC, Alsina M, Bensinger W, Biermann JS, Chanan-Khan A, Cohen AD, Devine S, Djulbegovic B, Faber EA Jr, Gasparetto C, Huff CA, Kassim A, Medeiros BC, Meredith R, Raje N, Schriber J, Singhal S, Somlo G, Stockerl-Goldstein K, Treon SP, Tricot G, Weber DM, Yahalom J, Yunus F, National Comprehensive Cancer Network (2011) Multiple Myeloma. J Natl Compr Cancer Netw 9:1146–1183. https://doi.org/10.6004/jnccn.2011.0095 CrossRef Anderson KC, Alsina M, Bensinger W, Biermann JS, Chanan-Khan A, Cohen AD, Devine S, Djulbegovic B, Faber EA Jr, Gasparetto C, Huff CA, Kassim A, Medeiros BC, Meredith R, Raje N, Schriber J, Singhal S, Somlo G, Stockerl-Goldstein K, Treon SP, Tricot G, Weber DM, Yahalom J, Yunus F, National Comprehensive Cancer Network (2011) Multiple Myeloma. J Natl Compr Cancer Netw 9:1146–1183. https://​doi.​org/​10.​6004/​jnccn.​2011.​0095 CrossRef
37.
Zurück zum Zitat Lazzarino M, Corso A, Barbarano L et al (2001) DCEP (dexamethasone, cyclophosphamide, etoposide, and cisplatin) is an effective regimen for peripheral blood stem cell collection in multiple myeloma. Bone Marrow Transplant 28:835CrossRefPubMed Lazzarino M, Corso A, Barbarano L et al (2001) DCEP (dexamethasone, cyclophosphamide, etoposide, and cisplatin) is an effective regimen for peripheral blood stem cell collection in multiple myeloma. Bone Marrow Transplant 28:835CrossRefPubMed
38.
Zurück zum Zitat Harousseau JL, Attal M, Avet-Loiseau H (2010) Bortezomib plus dexamethasone is superior to vincristine plus doxorubicin plus dexamethasone as induction treatment prior to autologous stem-cell transplantation in newly diagnosed multiple myeloma: results of the IFM 2005-01 phase III trial. J Clin Oncol 28:4621–4629CrossRefPubMed Harousseau JL, Attal M, Avet-Loiseau H (2010) Bortezomib plus dexamethasone is superior to vincristine plus doxorubicin plus dexamethasone as induction treatment prior to autologous stem-cell transplantation in newly diagnosed multiple myeloma: results of the IFM 2005-01 phase III trial. J Clin Oncol 28:4621–4629CrossRefPubMed
39.
Zurück zum Zitat Dadacaridou M, Papanicolaou X, Maltesas D et al Dexamethasone, cyclophosphamide, etoposide and cisplatin (DCEP) for relapsed or refractory multiple myeloma patients. J Buon 12:41–44 Dadacaridou M, Papanicolaou X, Maltesas D et al Dexamethasone, cyclophosphamide, etoposide and cisplatin (DCEP) for relapsed or refractory multiple myeloma patients. J Buon 12:41–44
43.
Zurück zum Zitat Rajkumar SV, Harousseau J-L, Durie B, Anderson KC, Dimopoulos M, Kyle R, Blade J, Richardson P, Orlowski R, Siegel D, Jagannath S, Facon T, Avet-Loiseau H, Lonial S, Palumbo A, Zonder J, Ludwig H, Vesole D, Sezer O, Munshi NC, San Miguel J, International Myeloma Workshop Consensus Panel 1 (2011) Consensus recommendations for the uniform reporting of clinical trials: report of the International Myeloma Workshop Consensus Panel 1. Blood 117:4691–4695. https://doi.org/10.1182/blood-2010-10-299487 CrossRefPubMedPubMedCentral Rajkumar SV, Harousseau J-L, Durie B, Anderson KC, Dimopoulos M, Kyle R, Blade J, Richardson P, Orlowski R, Siegel D, Jagannath S, Facon T, Avet-Loiseau H, Lonial S, Palumbo A, Zonder J, Ludwig H, Vesole D, Sezer O, Munshi NC, San Miguel J, International Myeloma Workshop Consensus Panel 1 (2011) Consensus recommendations for the uniform reporting of clinical trials: report of the International Myeloma Workshop Consensus Panel 1. Blood 117:4691–4695. https://​doi.​org/​10.​1182/​blood-2010-10-299487 CrossRefPubMedPubMedCentral
48.
Zurück zum Zitat Raje N, Berdeja J, Lin Y, Siegel D, Jagannath S, Madduri D, Liedtke M, Rosenblatt J, Maus MV, Turka A, Lam LP, Morgan RA, Friedman K, Massaro M, Wang J, Russotti G, Yang Z, Campbell T, Hege K, Petrocca F, Quigley MT, Munshi N, Kochenderfer JN (2019) Anti-BCMA CAR T-cell therapy bb2121 in relapsed or refractory multiple myeloma. N Engl J Med 380:1726–1737. https://doi.org/10.1056/NEJMoa1817226 CrossRefPubMedPubMedCentral Raje N, Berdeja J, Lin Y, Siegel D, Jagannath S, Madduri D, Liedtke M, Rosenblatt J, Maus MV, Turka A, Lam LP, Morgan RA, Friedman K, Massaro M, Wang J, Russotti G, Yang Z, Campbell T, Hege K, Petrocca F, Quigley MT, Munshi N, Kochenderfer JN (2019) Anti-BCMA CAR T-cell therapy bb2121 in relapsed or refractory multiple myeloma. N Engl J Med 380:1726–1737. https://​doi.​org/​10.​1056/​NEJMoa1817226 CrossRefPubMedPubMedCentral
Metadaten
Titel
DCEP and bendamustine/prednisone as salvage therapy for quad- and penta-refractory multiple myeloma
verfasst von
Scott R. Goldsmith
Mark A. Fiala
Brandon Wang
Mark A. Schroeder
Tanya M. Wildes
Armin Ghobadi
Keith Stockerl-Goldstein
Ravi Vij
Publikationsdatum
04.03.2020
Verlag
Springer Berlin Heidelberg
Erschienen in
Annals of Hematology / Ausgabe 5/2020
Print ISSN: 0939-5555
Elektronische ISSN: 1432-0584
DOI
https://doi.org/10.1007/s00277-020-03970-2

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