TITLE:
Selinexor, Carfilzomib, Pomalidomide, and Dexamethasone as a Salvage Regimen for Refractory and Relapsed Multiple Myeloma with Plasma-Cell Leukemia Transformation: A Case Report and Literature Review
AUTHORS:
Yanfang Zhang, Chen Ying, Yuchen Zhang, Jianchuan Deng
KEYWORDS:
Selinexor, Carfilzomib, Multiple Myeloma, Plasma Cell Leukemia
JOURNAL NAME:
Case Reports in Clinical Medicine,
Vol.11 No.7,
July
11,
2022
ABSTRACT: Refractory and relapsed multiple myeloma (RRMM) with plasma-cell leukemia (PCL) transformation is highly aggressive and resistant to conventional therapy. Novel therapeutics are needed for RRMM-transformed PCL. Selinexor [an oral exportin 1 (XPO1) inhibitor], carfilzomib (a second-in-class proteasome inhibitor), pomalidomide (third generation of immunomodulatory drug) are usually used for RRMM, but there are no reports on their application in PCL transformation. We describe a 62-year-old male initially diagnosed with MM IgD-lambda type with complex karyotype and extramedullary plasmacytoma in 2020, and relapsed after five months of autologous stem cell transplantation. Despite the use of various therapies, the patient rapidly developed into PCL over a 4-month period. The patient was started on selinexor, carfilzomib, pomalidomide, and dexamethasone (XKPd) combination as a salvage regimen in July 2021. He achieved fast response in first cycle. Then, he fulfilled third cycle of consolidation treatment and got four-month remission. The success of XKPd therapy in achieving a good response suggests its utility in RRMM transformed-PCL patients, who have exhausted various combinations of drug regimens and have historically poor survival outcomes.