bendamustine + pomalidomide + bortezomib + dexamethasone

This is a four-drug combination regimen consisting of bendamustine, pomalidomide, bortezomib, and dexamethasone. Each component has a distinct mechanism of action: - Bendamustine is a bifunctional alkylating agent that induces DNA crosslinking and cell death. - Pomalidomide is an immunomodulatory drug (IMiD) that exerts anti-myeloma effects through direct tumoricidal activity, immune modulation, and inhibition of angiogenesis. - Bortezomib is a proteasome inhibitor that disrupts protein degradation pathways in malignant plasma cells leading to apoptosis. - Dexamethasone is a synthetic glucocorticoid corticosteroid with anti-inflammatory and cytotoxic properties against lymphoid malignancies. This combination targets multiple pathways involved in the survival and proliferation of malignant plasma cells. It has been studied primarily for relapsed/refractory multiple myeloma (RRMM), especially in patients who are refractory to lenalidomide or have received multiple prior lines of therapy[1][2][3][4]. The addition of all four agents aims to overcome resistance mechanisms seen with doublet or triplet regimens.