Natural history of relapsed myeloma, refractory to immunomodulatory drugs and proteasome inhibitors: A multicenter IMWG study

S. K. Kumar, M. A. Dimopoulos, E. Kastritis, E. Terpos, H. Nahi, H. Goldschmidt, J. Hillengass, X. Leleu, M. Beksac, M. Alsina, A. Oriol, M. Cavo, E. M. Ocio, M. V. Mateos, E. K. O'Donnell, R. Vij, H. M. Lokhorst, N. W.C.J. Van De Donk, C. Min, T. MarkI. Turesson, M. Hansson, H. Ludwig, S. Jagannath, M. Delforge, C. Kyriakou, P. Hari, U. Mellqvist, S. Z. Usmani, D. Dytfeld, A. Z. Badros, P. Moreau, K. Kim, P. R. Otero, J. H. Lee, C. Shustik, D. Waller, W. J. Chng, S. Ozaki, J. J. Lee, J. De La Rubia, H. S. Eom, L. Rosinol, J. J. Lahuerta, A. Sureda, J. S. Kim, B. G.M. Durie

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187 Citations (Scopus)


Introduction of new myeloma therapies offers new options for patients refractory to immunomodulatory drugs (IMiDs) and proteasome inhibitors (PIs). In this multicenter study, patients with relapsed multiple myeloma, who have received at least three prior lines of therapy, are refractory to both an IMiD (lenalidomide or pomalidomide) and a PI (bortezomib or carfilzomib), and have been exposed to an alkylating agent were identified. The time patients met the above criteria was defined as time zero (T 0). Five hundred and forty-three patients diagnosed between 2006 and 2014 were enrolled in this study. Median age at T 0 was 62 years (range 31-87); 61% were males. The median duration between diagnosis and T 0 was 3.1 years. The median number of lines of therapy before T 0 was 4 (range 3-13). The median overall survival (OS) from T 0 for the entire cohort was 13 (95% confidence interval (CI) 11, 15) months. At least one regimen recorded after T 0 in 462 (85%) patients, with a median (95% CI) progression-free survival and OS from T 0 of 5 (4, 6), and 15.2 (13, 17) months, respectively. The study provides the expected outcome of relapsed multiple myeloma that is refractory to a PI and an IMiD, a benchmark for comparison of new therapies being evaluated.

Original languageEnglish
Pages (from-to)2443-2448
Number of pages6
Issue number11
Publication statusPublished - 2017 Nov 1

Bibliographical note

Funding Information:
1Department of Hematology, Mayo Clinic Rochester, Rochester, MN, USA; 2School of Medicine, National and Kapodistrian University of Athens, Athens, Greece; 3Division of Hematology, Karolinska Institutet, Karolinska University Hospital at Huddinge, Stockholm, Sweden; 4National Center for Tumor Diseases Heidelberg, Heidelberg, Germany; 5Department Med. V, University Hospital Heidelberg, Heidelberg, Germany; 6Oncologie hematologique et therapie cellulaire, chu de poitiers, Poitiers, France; 7Department of Hematology, Ankara University School of Medicine, Ankara, Turkey; 8Hematologic Malignancies Program, H. Lee Moffitt Cancer Center, Tampa, FL, USA; 9Department of Hematology, Skane University Hospital, Malmö, Sweden; 10Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy; 11Department of Hematology, University Hospital of Salamanca (HUS/IBSAL), Salamanca, Spain; 12Department of Hematolgy, Hospital Universitario de Salamanca, Salamanca, Spain; 13Massachusetts General Hospital, Boston, MA; 14Division of Oncology, Department of Medicine, Washington University School of Medicine, Saint Louis, MO, USA; 15Department of Hematology, VU University Medical Center, Amsterdam, The Netherlands; 16VU University Medical Center, Amsterdam, The Netherlands; 17Department of Hematology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, The Republic of Korea; 18Weill Cornell Medical College, New York, NY, USA; 19Department of Hematology, Skåne University Hospital, Lund University, Lund, Sweden; 20Department of Medicine, Center of Oncology, Hematology and Palliative Care, Wilhelminen Cancer Research Institute, Wilhelminenspital, Vienna, Austria; 21Department of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA; 22Myeloma Study Group, Belgian Hematological Society, Brussels, Belgium; 23Department of Haematology, North West London NHS Trust, NPH Hospital, London, UK; 24Division of Hematology/Oncology, Medical College of Wisconsin, Milwaukee, WI, USA; 25Section of Hematology and Coagulation, Department of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden; 26Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute/Carolinas HealthCare System, Charlotte, NC, USA; 27Department of Hematology and Bone Marrow Transplantation, University of Medical Sciences in Poznan, Poland, Poznan, Poland; 28Greenebaum Cancer Center, University of Maryland School of Medicine, Baltimore, MD, USA; 29Department of Hematology, Nantes University Hospital, Nantes, France; 30Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, The Republic of Korea; 31Clínica Universidad de Navarra, University of Navarra, Pamplona, Spain; 32Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, The Republic of Korea; 33Division of Haematology, McGill University Health Center, Montreal, QC, Canada; 34McGill University, Montreal, QC, Canada; 35Department of Haematology-Oncology, National University Health Systems, Singapore; 36Department of Hematology, Tokushima Prefectural Central Hospital, Tokushima, Japan; 37Department of Hematology-Oncology, Chonnam National University Hwasun Hospital, Jeollanamdo, The Republic of Korea; 38Hospital Dr. Peset, Valencia, Spain; 39HematologicOncology Clinic, Center for Specific Organs, National Cancer Center, Goyang, South Korea; 40Department of Hematology, Hospital Clinic iProvincial, Barcelona, Spain; 41Hospital Universitario 12 de Octubre, Madrid, Spain; 42Institut Català d'Oncologia, Hospital Duran i Reynals, Barcelona, Spain; 43Yonsei University College of Medicine, Severance Hospital, Seoul, The Republic of Korea and 44Samuel Oschin Comprehensive Cancer Institute, CedarsSinai Outpatient Cancer Center, Los Angeles, CA, USA. Correspondence: Dr SK Kumar, Department of Hematology, Mayo Clinic Rochester, 200 First Street, South West, Rochester, MN 55905, USA. E-mail: Received 1 February 2017; revised 4 April 2017; accepted 20 April 2017; accepted article preview online 12 May 2017; advance online publication, 16 June 2017

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© 2017 Macmillan Publishers Limited, part of Springer Nature. All rights reserved.

All Science Journal Classification (ASJC) codes

  • Hematology
  • Oncology
  • Cancer Research


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