New salvage vincristine, carmustine, cyclophosphamide, and prednisone (VBCP) chemotherapy for relapsed/refractory multiple myeloma in the modern era: A case series

We report our experience with vincristine, carmustine (BCNU), cyclophosphamide, and prednisone (VBCP), a regimen given in the outpatient setting to patients with multiple myeloma (MM) resistant to almost all the available novel/targeted therapies. Ten patients received salvage VBCP who were heavily pretreated with a median of 5.5 prior treatment regimens including lenalidomide, pomalidomide, bortezomib, carfilzomib, cyclophosphamide, and autologous stem cell transplantation. The objective response rate (≥PR) was 60%, with an additional 30% achieving stable disease (SD). The median time to progression for patients with ≥SD was 3.6 months. The median progression free survival was 4.4 months while the median overall survival was 12.8 months. Despite severe myelosuppression being the main toxicity, 61% of the subsequent cycles were given on time. Treatment-related mortality was not observed. Our results suggest VBCP is a highly active and tolerable salvage regimen among heavily pretreated MM patients who already failed many of the novel agents.