The lymphoma-like polychemotherapy regimen "Dexa-BEAM" in advanced and extramedullary multiple myeloma

Extramedullary disease (EMD) in multiple myeloma (MM) is characterised by an aggressive biology and an adverse prognosis especially when occurring at relapse. Due to the high proliferation found in EMD lesions, we analysed outcome data of patients treated with a lymphoma-type therapy not based on novel compounds, the Dexa-BEAM protocol. Retrospective analysis of MM patients having received Dexa-BEAM (including dexamethasone, carmustine, cytarabine, etoposide and melphalan) at our institution from January 2007 to November 2012. In all, 18 patients were identified, 11 of whom had EMD. Objective response (≥PR) to Dexa-BEAM was achieved in more than half of the patients with EMD (6/11); consecutive high-dose consolidation strategy with autologous or allogeneic stem cell transplantation improved upon the depth of remission in two thirds of EMD patients (4/6) with ongoing remissions in three patients. In contrast, all patients without consolidation relapsed. Progression-free survival after Dexa-BEAM was short in both patient groups with intramedullary or extramedullary myeloma with a median of 3 and 4 months, respectively. Toxicity was relevant with one treatment-related death and grades 3 and 4 toxicities in all 18 patients. Dexa-BEAM is an effective induction regimen in medically fit patients with extramedullary manifestations to regain disease control prior to an intended autologous or allogeneic transplantation.