Phase Ib/II trial of CYKLONE (cyclophosphamide, carfilzomib, thalidomide and dexamethasone) for newly diagnosed myeloma

Sixty-four transplant-eligible patients with newly diagnosed multiple myeloma (NDMM) received carfilzomib (days 1, 2, 8, 9, 15, 16), 300mg/m(2) cyclophosphamide (days 1, 8, 15), 100mg thalidomide (days 1-28) and 40mg dexamethasone (days 1, 8, 15, 22) in 28-day cycles (CYKLONE regimen). Carfilzomib was dose-escalated to 15/20, 20/27, 20/36 and 20/45mg/m(2) to determine the maximum tolerated dose (MTD), which was 20/36mg/m(2). Regardless of attribution, common Grade 3 or higher adverse events were lymphopenia (38%), neutropenia (23%) and anaemia (20%). All peripheral neuropathy (31%) was Grade 1 and considered most likely to be thalidomide-related. Common cardiac or pulmonary events of any grade in 5% of patients included dyspnoea (20%) and cough (6%). Overall (N=64), 91% of patients achieved a best response of partial response or better across all cycles of treatment, including five patients with complete responses. At the MTD (n=29), 59% of patients achieved a very good partial response or better after four cycles (primary end point). Stem cell collection was successful in all patients in whom it was attempted (n=42). Progression-free survival and overall survival at 24months was 76% and 96%, respectively (median follow-up of 175months). CYKLONE appears highly efficacious in NDMM patients, with manageable toxicities.