Use of KRD-PACE as Salvage Therapy in Aggressive, RelapsedBortezomib-Refractory Extramedullary Multiple Myeloma: A Report of Two Cases and Literature Review

Abstract EN

Extramedullary multiple myeloma is defined by the presence of plasma cell infiltration outside of the bone marrow.

It is associated with a poor prognosis and resistance to therapy and is often associated with high-risk cytogenetics.

Aggressive relapsed and refractory extramedullary multiple myeloma is often treated with salvage infusional chemotherapy to achieve rapid disease control.

Commonly used regimens include DCEP, CVAD, and VTD-PACE.

While VTD-PACE contains bortezomib and thalidomide which have potent antimyeloma activity, the advent of novel agent therapy with proteasome inhibitors and immunomodulatory agents being used in the first-line setting has resulted in many patients being refractory to bortezomib by the time they are treated with VTD-PACE.

Herein, we discuss two cases of aggressive relapsed, high-risk, bortezomib-refractory extramedullary multiple myeloma treated with KRD-PACE and review the available clinical data on salvage chemotherapy regimens used in relapsed refractory myeloma.