Real-world effectiveness and safety of carfilzomib, pomalidomide, and dexamethasone in relapsed/refractory multiple myeloma: a retrospective analysis from China

Background: Pomalidomide, a next-generation immunomodulatory drug (IMiD), and carfilzomib, a novel proteasome inhibitor (PI), have been separately approved in combination regimens for relapsed/refractory multiple myeloma (RRMM). However, real-world data, particularly for Chinese RRMM patients with prior-line treatment, including lenalidomide and bortezomib, remain limited. Methods: We retrospectively analyzed RRMM patients treated with KPd between October 2022 and December 2024 at two Chinese centers. Results: This study included 34 patients who received KPd. The median age was 65 years. All patients were bortezomib-exposed, 91.2% were lenalidomide-exposed (and refractory), and 50.0% were daratumumab-exposed. The overall response rate (ORR) was 82.4% and was significantly influenced by high-risk cytogenetics, prior daratumumab exposure, and the receipt of ≥ 3 prior lines of therapy. The median progression-free survival (PFS) was 13 months, with a 2-year PFS rate of 40.3%. Hematologic toxicities were the most common adverse events (AEs) (73.5%), and grade 3/4 AEs occurred in 58.8% of patients. Conclusions: KPd exhibited substantial effectiveness in this real-world cohort of heavily pretreated Chinese RRMM patients, including those with lenalidomide-refractory disease. However, the high incidence of hematologic toxicities necessitates careful monitoring and management.