Combination therapy incorporating Bcl-2 inhibition with Venetoclax for the treatment of refractory primary plasma cell leukemia with t (11;14)

Eur J Haematol. 2018 Feb;100(2):215-217. doi: 10.1111/ejh.12986. Epub 2017 Nov 16.

Abstract

Primary plasma cell leukemia (pPCL) is the most aggressive form of the plasma cell (PC) malignancy, multiple myeloma (MM). It has been commonly associated with the presence of a chromosome translocation involving the immunoglobulin heavy chain (IgH) locus on 14q32, that is t (11;14). Results from early phase clinical trials utilizing the selective Bcl-2 inhibitor, venetoclax, as a single agent in patients with relapsed MM have had remarkable efficacy among patients with t (11;14) abnormality. The present case demonstrates the ability of a combination regimen incorporating Bcl-2 inhibition with daratumumab, bortezomib, venetoclax, and dexamethasone to induce a rapid and very deep hematologic response in a pPCL patient with t (11;14), even in a setting of very refractory disease. This case highlights the need to further study Bcl-2 inhibition-based therapy as an option for therapy in patients with pPCL with t (11;14).

Keywords: Bcl-2 inhibition; Venetoclax; plasma cell leukemia.

Publication types

  • Case Reports

MeSH terms

  • Antineoplastic Combined Chemotherapy Protocols / adverse effects
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use*
  • Biomarkers
  • Bone Marrow / pathology
  • Bridged Bicyclo Compounds, Heterocyclic / administration & dosage
  • Chromosomes, Human, Pair 11*
  • Chromosomes, Human, Pair 14*
  • Drug Resistance, Neoplasm
  • Female
  • Humans
  • Immunoglobulin kappa-Chains / blood
  • Leukemia, Plasma Cell / diagnosis
  • Leukemia, Plasma Cell / drug therapy*
  • Leukemia, Plasma Cell / genetics*
  • Middle Aged
  • Proto-Oncogene Proteins c-bcl-2 / antagonists & inhibitors
  • Retreatment
  • Sulfonamides / administration & dosage
  • Translocation, Genetic*
  • Treatment Outcome

Substances

  • Biomarkers
  • Bridged Bicyclo Compounds, Heterocyclic
  • Immunoglobulin kappa-Chains
  • Proto-Oncogene Proteins c-bcl-2
  • Sulfonamides
  • venetoclax