Onkológia S3/2018

Four year continuation of treatment response in a patient with advanced myeloma–a case report

Objective: Pomalidomide in combination with dexamethasone was approved for the treatment of relapsed, refractory multiple myeloma in the European Union in August 2013. It has not yet been listed as a categorized drug in Slovakia; the experience with its use is limited and data on treatment outcomes in real-life clinical practice in local conditions is missing. Case study: We present the case of heavily pre-treated female patient with relapsed refractory multiple myeloma, treated with pomalidomide in combination with dexamethasone in standard dosage according to the Summary of Product Characteristic since June 2014. Her pre-existing neutropenia deepened with treatment, which repeatedly lead to the delay of the cycle and the use of growth factors. Therefore, pomalidomide dose was lowered to 3 mg as of cycle 5. Dexamethasone was also gradually decreased and as of July 2016, replaced with prednisone. The patient reached partial response as early as after cycle 2; later, we observed very good partial response, which remains lasting. This quality of response to pomalidomide in advanced disease is remarkable also with regards to the fact that only partial response was reached after the initial bortezomib-based treatment and that with the autologous stem cell transplant, only stable disease was achieved. A significant benefit of pomalidomide treatment is also the improvement of performance status to ECOG 0, no further need for pain treatment with opioids and a good quality of life. The patient received 37 therapeutic cycles during 4 years and we plan to continue the treatment until progression. Conclusion: The presented case study validates certain published data, according to which pomalidomide had better results in clinical practice than in studies. The fast and enhancing therapeutic response, which has been lasting in our patient for four years, together with a good tolerability, proves the ability of pomalidomide to change the course of the disease, even in an advanced stage, and prolong survival while maintaining quality of life.

Keywords: multiple myeloma, immunomodulatory drug, pomalidomide