Efficacy of Daratumumab-Containing Regimens Among Patients With Multiple Myeloma Progressing on Lenalidomide Maintenance: Retrospective Analysis

A real-life study of daratumumab-bortezomib-dexamethasone (D-VD) in lenalidomide exposed/refractory multiple myeloma patients: a report from the Triveneto Myeloma Working Group

Treatment of lenalidomide refractory (Len-R) multiple myeloma (MM) patients still represents an unmet clinical need. In the last years, daratumumab-bortezomib-dexamethasone (D-VD) combination was extensively used in this setting, even though only a small fraction of Len-R patients was included in the pivotal trial. This real-life study aimed to evaluate the efficacy and safety of the D-VD regimen in a cohort that exclusively enrolled Len exposed or refractory MM patients. The study cohort included 57 patients affected by relapsed/refractory MM. All patients were previously exposed to Len, with 77.2% being refractory. The overall response rate (ORR) was 79.6% with 43% of cases obtaining at least a very good partial response (VGPR). The D-VD regimen showed a favorable safety profile, with low frequency of grade 3-4 adverse events, except for thrombocytopenia observed in 21.4% of patients. With a median follow-up of 13 months, median progression-free survival (PFS) was 17 months. No significant PFS differences were observed according to age, ISS, LDH levels, type of relapse, and high-risk FISH. Len exposed patients displayed a PFS advantage as compared to Len refractory patients (29 vs 16 months, p = 0.2876). Similarly, patients treated after Len maintenance showed a better outcome as compared to patients who had received a full-dose Len treatment (23 vs 13 months, p = 0.1728). In conclusion, our real-world data on D-VD combination showed remarkable efficacy in Len-R patients, placing this regimen as one of the standards of care to be properly taken into account in this MM setting.

A case of Multiple Myeloma with lung plasmacytoma

Multiple Myeloma (MM) is a malignant proliferation of the plasma cells mainly affecting bone marrow. Most common sites of extramedullary dissemination reported in the literature are skin, liver, kidneys and central nervous system. Multiple Myeloma is rarely associated with lung plasmacytoma. In fact; dissemination of MM in lung is relatively uncommon being described in only 5% of cases and therefore the diagnosis of this entity can be misleading to most clinicians. We report a rare case of lung plasmacytoma with MM in a 65-year-old, smoker, male who presented with shortness of breath and a heterogeneous mass involving the lower left lobe visualized on CT scan. Careful integration of the clinical manifestations with the radiological and pathological data from CT-guided transparietal lung biopsy and bone marrow biopsy led to the diagnosis of Multiple Myeloma with lung plasmacytoma. Given the rarity of this localization, the purpose of this study was to increase knowledge of this disease among pulmonologists, in order to provide more timely diagnosis.