Pomalidomide, Cyclophosphamide, and Dexamethasone for Relapsed/Refractory Multiple Myeloma: A Single-Center Experience.

Introduction: Pomalidomide, a third-generation IMiD, has shown efficacy in relapsed/refractory multiple myeloma (RRMM). The addition of cyclophosphamide to pomalidomide and dexamethasone (PCd) has been explored as a potential therapeutic option in this challenging setting.

Methods: We conducted a retrospective analysis of RRMM patients treated with PCd in the Department of Clinical Therapeutics, Athens, Greece. Eligible patients had histologically confirmed MM, received ≥ 1 prior therapy, and experienced disease progression.

Results: A total of 45 RRMM patients were treated with PCd in our department, with a median of 2 prior lines of therapy. The median follow-up from the time of diagnosis of symptomatic MM was 7.8 years and it was 21.1 months from the initiation of PCd. The ORR was 46.7% and the DCR was 66.7%. The median TTNT, PFS and OS were 14.6 months, 9.0 months and 21.0 months, respectively. Age, number of prior lines of therapy and exposure to lenalidomide at the immediate prior line did not seem to impact patient outcomes. On the other hand, patients harboring expanded high-risk cytogenetics at MM diagnosis, experienced particularly worse PFS (aHR = 3.08, 95% CI, 1.33-7.17) and DCR (42.9% vs. 77.4%, P = .039), compared to those with no abnormalities. Finally, the most common severe grade 3/4 toxicity was neutropenia.

Conclusion: The addition of cyclophosphamide to Pd in moderately to heavily pretreated RRMM patients showed promising efficacy, supporting PCd as a potential therapeutic option in real-world clinical settings.