14 June 2022

Multiple myeloma patients may benefit from an autologous stem cell transplant after a triple-combination of drugs, according to a newly reported study.

Patients who received the transplant immediately after induction therapy had longer progression-free survival than those who received the three-drug combination alone. However, there was no difference in overall survival between the two groups.

Dr Paul Richardson of Dana-Farber Cancer Institute in Boston, USA and colleagues, gave a group of more than 700 adult patients with newly diagnosed multiple myeloma so-called 'triplet' therapy of lenalidomide, bortezomib, and dexamethasone.

All patients in the trial received this combination, and half were chosen at random to receive an autologous stem cell transplant. The other half had stem cells collected for a potential transplant at a later date. Both groups then received lenalidomide maintenance therapy until progression or unacceptable side-effects.

After a follow-up of about 76 months, the risk of disease progression or death was 53% higher in the group which only received the triplet drug therapy than in the group that also received a stem cell transplant.

However, five-year survival rates were not significantly different, at around 80% for both groups.

Findings were published in the New England Journal of Medicine and presented at the Annual Meeting of the American Society of Clinical Oncology (ASCO).

Dr Richardson said: “Now more than ever, treatment for multiple myeloma can be adapted for each patient.

“Our study provides important information about the benefits of transplant in the era of highly effective novel therapies and continuous maintenance, as well as the potential risks, to help patients and their physicians decide what approach may be best for them.

“This is particularly relevant as we have now further improved the induction treatment for younger patients with newly diagnosed myeloma.”

He adds that the study “also suggests that maintenance with lenalidomide really matters and using it until progression is key to improving outcome”.

Source: Richardson PG, Jacobus SJ, Weller EA, Hassoun H, Lonial S, Raje NS, Medvedova E, McCarthy PL, Libby EN, Voorhees PM, Orlowski RZ, Anderson LD Jr, Zonder JA, Milner CP, Gasparetto C, Agha ME, Khan AM, Hurd DD, Gowin K, Kamble RT, Jagannath S, Nathwani N, Alsina M, Cornell RF, Hashmi H, Campagnaro EL, Andreescu AC, Gentile T, Liedtke M, Godby KN, Cohen AD, Openshaw TH, Pasquini MC, Giralt SA, Kaufman JL, Yee AJ, Scott E, Torka P, Foley A, Fulciniti M, Hebert K, Samur MK, Masone K, Maglio ME, Zeytoonjian AA, Nadeem O, Schlossman RL, Laubach JP, Paba-Prada C, Ghobrial IM, Perrot A, Moreau P, Avet-Loiseau H, Attal M, Anderson KC, Munshi NC; on behalf of DETERMINATION Investigators. (2022) “Triplet Therapy, Transplantation, and Maintenance until Progression in Myeloma (DETERMINATION).” New England Journal of Medicine, doi: 10.1056/NEJMoa2204925

Link: https://www.nejm.org/doi/full/10.1056/NEJMoa2204925

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