Startseite Kongressberichte & Archiv EHA2021 Virtual Congress Chronic lymphoid malignancies New treatment strategies for newly diagnosed multiple myeloma

New treatment strategies for newly diagnosed multiple myeloma

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The study authors conclude that CASSIOPEIA part 2 interim analysis showed a significantly longer progression-free survival with daratumumab maintenance versus observation in transplant-eligible patients with NDMM. The maintenance progression-free survival benefit appeared only in patients treated with VTd as induction/consolidation. Patients who received D-VTd induction/consolidation ± daratumumab maintenance achieved similar progression-free survival; longer follow-up is needed for overall survival and PFS2. Compared with observation, daratumumab maintenance significantly increased deeper response and MRD negativity rates, and it was well tolerated with no new safety signals.

 

The study authors report, to their knowledge for the first time, on a trial forultra high-risk (UHiR) newly diagnosed multiple myeloma (NDMM) and plasma cell leukemia (PCL) investigating daratumumab, cyclophosphamide, bortezomib, lenalidomide, dexamethasone (Dara-CVRd)  induction, and augmented ASCT. Response rates and MRD-negativity were high in this difficult-to-treat patient population, with toxicity comparable to other induction regimens. However, some early progressions highlight the need for innovative approaches to UHiR NDMM and PCL.

 

The study authors conclude that carfilzomib-lenalidomide-dexamethasone induction/consolidation with ASCT (KRd_ASCT) and KR maintenance are highly effective in standard risk (SR), single high-risk (HiR) and double hit (DH) patients, with impressive 1y-MRD neg rates (KRd_ASCT: HiR 50%, DH 47%), 4-year progression-free survival from diagnosis (KRd_ASCT: HiR 62%, DH 55%) and 3-year progression-free survival from maintenance (KR: HiR 69%, DH 67%), thus supporting their use in HiR patients, who represent an unmet medical need. Achieving 1y-MRD neg mitigated the higher risk of progression/death in HiR and DH patients, as compared to SR patients.

 

The study authors report with a best ORR of 100% during quadruplet induction treatment an update of the IA for progression-free survival of the first 50 patients in the CONCEPT trial. In these solely HR NDMM patients an encouraging progression-free survival rate of 79.6% and 75.5% after 12- and 24-months is reported. Their data underline the high potency of quadruplet treatment with Isa-KRd especially in patients with HR disease. The study completed recruitment, further results will be reported.

The study authors conclude that this large dataset demonstrated that the prognostic value of MRD status at the start of maintenance can be enhanced by measuring MRD kinetics during treatment. Their results support the achievement and sustainability of MRD negativity as a treatment endpoint in the maintenance setting and showed poor outcomes in MRD− patients converting to MRD+, underscoring the value of serial MRD assessments to anticipate relapse and guide treatment decisions. Accordingly, ixazomib showed significant progression-free survival benefit versus placebo in patients who were MRD+ at study entry and pts with persistent MRD.