Cyclophosphamide etoposide dexamethasone (CED) as salvage and bridging therapy in relapsed refractory and extramedullary multiple myeloma.

Patients with relapsed refractory multiple myeloma (RRMM) that are triple-exposed to immunomodulatory drugs, proteasome inhibitors, and anti-CD38 monoclonal antibodies have a poor prognosis. Standard treatment for these patients has not been established. Patients with extramedullary disease or secondary plasma cell leukaemia often display high tumour cell proliferation and might therefore be susceptible to chemotherapy. While current regimens are often platinum-based, we present single-centre data on 70 patients with RRMM who were treated with cyclophosphamide, etoposide, and dexamethasone (CED) after a median of four lines of therapy. An overall response rate of 52% was achieved after 1 to 6 cycles, with 23% of patients having a very good partial response. Comparable response rates and survival were observed in patients with extramedullary disease and high-risk cytogenetics. Treatment resulted in non-haematological °III-IV adverse events in 31 % of patients. No treatment-related deaths occurred. The median progression-free and overall survival were 6.2 months and 10.9 months, respectively. 23% of patients were bridged to autologous stem cell transplantation (ASCT) or chimeric antigen receptor (CAR) T cell therapy. In summary, CED is an effective treatment regimen for RRMM cases with a tolerable safety profile and suitable as bridging therapy to CAR T cell treatment and ASCT. This article is protected by copyright. All rights reserved.