{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T03:21:21Z","timestamp":1785468081511,"version":"3.56.0"},"reference-count":31,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2019,6,19]],"date-time":"2019-06-19T00:00:00Z","timestamp":1560902400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: The ASPIRE (NCT01080391) phase 3 trial showed the efficacy of carfilzomib, lenalidomide and dexamethasone (KRd) triplet for relapse and refractory multiple myeloma (RRMM). However, little is known about safety and efficacy of KRd outside a clinical trial context. Methods: Herein we report real life results of KRd given to 130 RRMM patients from 12 Sicilian Centers. Results: Median age was 62 years; patients had received a median of two previous lines of treatment (range 1\u201310) and 52% were refractory to previous treatment. Median number of KRd cycles was 12 (2\u201329), with a mean duration of treatment of 12 months; 21 patients had received at least 18 cycles. Overall response rate was 61%, including 18% complete response. Median PFS was 22.9 months, median OS was not reached. Creatinine clearance &gt;30 mL\/min, quality of the best achieved response and standard Fluorescence In Situ Hybridization (FISH) risk were independent predictors of favorable outcome. Patients who received the full-dosage of carfilzomib in the first two cycles had a better outcome. Conclusions: KRd was effective and well tolerated and in a considerable proportion of patients, therapy continued beyond the 18th cycle. The finding of a better outcome in patients with the higher cumulative dose of carfilzomib in the first two cycle encourages to maintain the maximum tolerated dose.<\/jats:p>","DOI":"10.3390\/jcm8060877","type":"journal-article","created":{"date-parts":[[2019,6,19]],"date-time":"2019-06-19T10:43:32Z","timestamp":1560941012000},"page":"877","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":25,"title":["Feasibility, Tolerability and Efficacy of Carfilzomib in Combination with Lenalidomide and Dexamethasone in Relapsed Refractory Myeloma Patients: A Retrospective Real-Life Survey of the Sicilian Myeloma Network"],"prefix":"10.3390","volume":"8","author":[{"given":"Concetta","family":"Conticello","sequence":"first","affiliation":[{"name":"Division of Hematology, Azienda Policlinico-OVE, University of Catania, 95125 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6333-4433","authenticated-orcid":false,"given":"Alessandra","family":"Romano","sequence":"additional","affiliation":[{"name":"Division of Hematology, Azienda Policlinico-OVE, University of Catania, 95125 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vittorio","family":"Del Fabro","sequence":"additional","affiliation":[{"name":"Division of Hematology, Azienda Policlinico-OVE, University of Catania, 95125 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Enrica Antonia","family":"Martino","sequence":"additional","affiliation":[{"name":"Division of Hematology, Azienda Policlinico-OVE, University of Catania, 95125 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valeria","family":"Calafiore","sequence":"additional","affiliation":[{"name":"Division of Hematology, Azienda Policlinico-OVE, University of Catania, 95125 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuseppe","family":"Sapienza","sequence":"additional","affiliation":[{"name":"Division of Hematology, Azienda Policlinico-OVE, University of Catania, 95125 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valerio","family":"Leotta","sequence":"additional","affiliation":[{"name":"Division of Hematology, Azienda Policlinico-OVE, University of Catania, 95125 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marina Silvia","family":"Parisi","sequence":"additional","affiliation":[{"name":"Division of Hematology, Azienda Policlinico-OVE, University of Catania, 95125 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Uros","family":"Markovic","sequence":"additional","affiliation":[{"name":"Division of Hematology, Azienda Policlinico-OVE, University of Catania, 95125 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bruno","family":"Garibaldi","sequence":"additional","affiliation":[{"name":"Division of Hematology, Azienda Policlinico-OVE, University of Catania, 95125 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Salvatore","family":"Leotta","sequence":"additional","affiliation":[{"name":"Division of Hematology, Azienda Policlinico-OVE, University of Catania, 95125 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emilia","family":"Cotzia","sequence":"additional","affiliation":[{"name":"U.O.C. Ematologia, ASP8, 96100 Siracusa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vanessa","family":"Innao","sequence":"additional","affiliation":[{"name":"Division of Hematology, Dipartimento di Patologia Umana dell\u2019Adulto e dell\u2019Et\u00e0 Evolutiva, Policlinico G. Martino, University of Messina, 98122 Messina, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8665-1258","authenticated-orcid":false,"given":"Donato","family":"Mannina","sequence":"additional","affiliation":[{"name":"U.O.C. Ematologia, Azienda Ospedaliera Papardo, 98158 Messina, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Santo","family":"Neri","sequence":"additional","affiliation":[{"name":"U.O.C. Ematologia, Azienda Ospedaliera Papardo, 98158 Messina, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maurizio","family":"Musso","sequence":"additional","affiliation":[{"name":"U.O.C. OncoEmatologia e TMO, Dipartimento Oncologico, La Maddalena, 90146 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Renato","family":"Scalone","sequence":"additional","affiliation":[{"name":"U.O.C. OncoEmatologia e TMO, Dipartimento Oncologico, La Maddalena, 90146 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clotilde","family":"Cangialosi","sequence":"additional","affiliation":[{"name":"U.O.C. Ematologia A. O. Ospedali Riuniti Villa Sofia-Cervello, 90146 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Acquaviva","sequence":"additional","affiliation":[{"name":"U.O.C. Ematologia A. O. Ospedali Riuniti Villa Sofia-Cervello, 90146 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5072-2728","authenticated-orcid":false,"given":"Giovanni","family":"Cardinale","sequence":"additional","affiliation":[{"name":"U.O.C. Ematologia, ARNAS-Civico-Di Cristina-Benfratelli, 90147 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anxur","family":"Merenda","sequence":"additional","affiliation":[{"name":"U.O.C. Ematologia, ARNAS-Civico-Di Cristina-Benfratelli, 90147 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cinzia","family":"Maugeri","sequence":"additional","affiliation":[{"name":"Division of Hematology, Sant\u2019Elia Hospital, 93100 Caltanissetta, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuseppina","family":"Uccello","sequence":"additional","affiliation":[{"name":"U.O.C. Ematologia, ARNAS Garibaldi, 95122 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Massimo","family":"Poidomani","sequence":"additional","affiliation":[{"name":"SIMT Hematology, ASP7, 97100 Ragusa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuseppe","family":"Longo","sequence":"additional","affiliation":[{"name":"U.O.C. Ematologia, Ospedale San Vincenzo, 98039 Taormina (ME), Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melania","family":"Carlisi","sequence":"additional","affiliation":[{"name":"U.O.C. Ematologia, Policlinico P. Giaccone, 90127 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4416-8556","authenticated-orcid":false,"given":"Daniele","family":"Tibullo","sequence":"additional","affiliation":[{"name":"Department of Biomedical and Biotechnological Science, University of Catania, 95125 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Di Raimondo","sequence":"additional","affiliation":[{"name":"Division of Hematology, Azienda Policlinico-OVE, University of Catania, 95125 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2019,6,19]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1038\/leu.2011.196","article-title":"Risk of progression and survival in multiple myeloma relapsing after therapy with IMiDs and bortezomib: A multicenter international myeloma working group study","volume":"26","author":"Kumar","year":"2012","journal-title":"Leukemia"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1016\/S1470-2045(15)00464-7","article-title":"Carfilzomib and dexamethasone versus bortezomib and dexamethasone for patients with relapsed or refractory multiple myeloma (ENDEAVOR): A randomised, phase 3, open-label, multicentre study","volume":"17","author":"Dimopoulos","year":"2016","journal-title":"Lancet Oncol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1195","DOI":"10.1016\/S1470-2045(14)70440-1","article-title":"Panobinostat plus bortezomib and dexamethasone versus placebo plus bortezomib and dexamethasone in patients with relapsed or relapsed and refractory multiple myeloma: A multicentre, randomised, double-blind phase 3 trial","volume":"15","author":"Hungria","year":"2014","journal-title":"Lancet Oncol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"754","DOI":"10.1056\/NEJMoa1606038","article-title":"Daratumumab, Bortezomib, and Dexamethasone for Multiple Myeloma","volume":"375","author":"Palumbo","year":"2016","journal-title":"N. 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