Pomalidomide- and dexamethasone-based regimens in the treatment of refractory/ relapsed multiple myeloma

Pomalidomide is a potent immunomodulatory agent that is currently a standard of care backbone for the treatment of multiple myeloma (MM) patients in the relapsed/ refractory setting after exposure to lenalidomide and a proteasome inhibitor. Pomalidomide has direct myeloma cell tumoricidal effects by activating proteasomal degradation of Ikaros and Aiolos transcription factors and also indirect effects by modulation of immune responses, interaction with bone marrow stromal cells, and inhibition of angiogenesis. The present review addresses current knowledge regarding the clinical use of pomalidomide in relapsed myeloma patients. The pomalidomidedexamethasone (Pd) regimen is used either alone or in combination with other antitumor drugs. Several studies evaluated the efficacy and safety of triplets containing pomalidomide-dexamethasone + proteasome inhibitors, monoclonal antibodies (daratumumab, elotuzumab) in relapses/refractory myeloma patients. Several Pdbased triplets are currently approved by the FDA/ EMA for these patients. Pomalidomide is one of the powerful tools available for use in relapsed/refractory myeloma patients. Understanding the synergistic immunomodulatory effects of pomalidomide and other antimyelomic agents and mechanisms that overcome clonal resistance will potentially allow the targeted use of triple combinations for each relapse. Pomalidomide has a controlled and well-understood toxicity, is an oral agent and does not require correction in case of detection.