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Lenalidomide and dexamethasone are an effective treatment for naïve and relapsed multiple myeloma (MM) patients. Bendamustine is a good option for B-cell malignancies showing only partial cross resistance with alkylating agents used in MM patients. Based on these considerations, we proposed a phase I/II study testing escalating doses of bendamustine and lenalidomide and fixed low doses of dexamethasone (BdL). Fifteen patients were enrolled in phase I study. Maximum tolerated dose was established at dose “level 0”: bendamustine 40 mg/m2days 1,2; lenalidomide 10 mg days 1–21; d 40 mg days 1,8,15,22 every 28-day cycle, for six cycles. We enrolled 23 patients in the phase II study. BdL combination showed mainly hematological toxicities, fever and infections. Overall response rate was 47%. After median follow up of 22 months, median PFS was 10 months. Two-years OS rate was 65%. BdL combination confirmed to be a promising treatment for patients with relapsed/refractory MM. [ABSTRACT FROM PUBLISHER]

The article discusses research which investigated the switch from intravenous (IV) to subcutaneous (SC) bortezomib administration for treatment of multiple myeloma (MM) patients. The advantages of SC over IV administration are discussed including cost and time saving and better tolerance. The article compared the efficacy and toxicity of SC and IV in transplant-eligible, frail older and relapsed patients and confirmed the efficacy of SC in limiting the severity of peripheral neuropathy (PN).

The aim of this phase II trial was to investigate the efficacy of bortezomib plus dexamethasone (Vel-Dex) as induction therapy in patients with multiple myeloma (MM) and to define the role of intensification before transplantation. Fifty-seven patients were treated with four courses of Vel-Dex, two cycles of dexamethasone, cyclophosphamide, etoposide and cisplatin (DCEP), and a single autologous transplant. Fourteen patients (25%) went off-study: seven after Vel-Dex, seven after DCEP. All patients yielded high numbers of stem cells (median CD34+ cells 7.5 × 106/kg); 54 of the 57 patients (94%) collected ≥4 × 106/kg CD34+ cells, 60% with a single leukapheresis. The overall response rate (ORR) after Vel-Dex was 86% (70% had a very good partial response [VGPR] or better) regardless of cytogenetic abnormalities and International Staging System stage (ISS). The response at the end of the two DCEP cycles remained unchanged in 35 patients (70%), worsened in 15 (20%), and improved in 5 (10%). Because of the consistent drop-out, the ORR in intention-to-treat analysis decreased significantly from 86% after Vel-Dex to 76% after DCEP, and 73% after transplantation. However, when considering the subset of 43 patients who completed the program, the ORR was 96% (complete response 39%, VGPR 41%, partial response 16%). In conclusion, Vel-Dex produces high response rates, improves stem cell collection, and overcomes the need for intensification before autologous transplantation. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented regarding an in vivo confocal study which used the corneal confocal microscopy (CCM) to identify and follow-up diabetic peripheral neuropathy (PN) in multiple myeloma patients treated with bortezomib.

The article reports on research which was conducted to determine the effectiveness of the carboxy terminal telopeptide (CTX) test in predicting the development of bone disease in patients with multiple myeloma (MM) during bisphosphonate therapy. Researchers evaluated 84 patients. They found that CTX was capable of defining bone disease in MM patients undergoing treatment with bisphosphonates.

A letter to the editor is presented which discusses a study that aims to test the possibility of lowering the total dose of thalidomide administered to patients with multiple myeloma (MM) to reduce the incidence of peripheral neuropathy (PN).