DCEP and bendamustine/prednisone as salvage therapy for quad- and penta-refractory multiple myeloma

Scott R. Goldsmith, Mark A. Fiala, Brandon Wang, Mark A. Schroeder, Tanya M. Wildes, Armin Ghobadi, Keith Stockerl-Goldstein, Ravi Vij

Research output: Contribution to journalArticlepeer-review

13 Scopus citations


Multiple myeloma (MM) almost invariably progresses through novel therapies. Patients with quad-refractory MM (refractory to bortezomib, carfilzomib, lenalidomide, and pomalidomide) and penta-refractory MM (additional refractoriness to daratumumab) have few treatment options. Two chemotherapy regimens, bendamustine/prednisone (BP) and dexamethasone, cyclophosphamide, etoposide, and cisplatin (DCEP), are often used in quad- and penta-refractory MM, but there are limited data on outcomes in this heavily pre-treated population. We conducted a single-center retrospective study to identify all patients who received DCEP and/or BP for quad- or penta-refractory MM. Disease response and refractoriness were defined by International Myeloma Working Group criteria. The primary endpoint was overall response rate (ORR). Secondary endpoints included overall survival (OS), progression-free survival (PFS), and duration of response (DOR). We identified 27 patients who received BP for quad- or penta-refractory MM. The median number of prior lines of therapy was 6. The ORR for BP was 26%. The median PFS for BP was 1.4 months (95% CI 1.1–1.6) and median OS was 8.7 months (95% CI 2.3–15.0). Patients treated with cyclophosphamide had less response to BP. Thirty-one patients received DCEP for quad-refractory or penta-refractory MM. The median number of prior treatment regimens was 8. The ORR to DCEP was 35%. The median PFS was 2.7 months (95% CI 1.5–3.8) and median OS was 6.2 months (95% CI 4.4–7.8). DCEP and BP retain efficacy in quad- and penta-refractory MM. Our analysis supports prospective study of these regimens, possibly in combination or in comparison with other agents in this area of unmet need.

Original languageEnglish
Pages (from-to)1041-1048
Number of pages8
JournalAnnals of Hematology
Issue number5
StatePublished - May 1 2020


  • Bendamustine
  • DCEP
  • Penta-refractory multiple myeloma
  • Quad-refractory multiple myeloma
  • Salvage therapy


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