Multiple Myeloma Coverage from Every Angle

Carfilzomib-Based Therapy for Transplant-Eligible Patients With Myeloma

By: Joseph Fanelli
Posted: Wednesday, November 27, 2019

For newly diagnosed patients with multiple myeloma who are eligible for transplantation, the four-drug regimen of KCRD—the second-generation proteasome inhibitor carfilzomib plus cyclophosphamide, lenalidomide, and dexamethasone—may offer better results and be a more tolerated treatment than sequential triplet therapies, according to the results presented at the 2019 International Myeloma Workshop (IMW) in Boston (Abstract OAB-002). The phase III Myeloma XI trial, from the UK’s National Cancer Research Institute, found that KRCD offered a significant progression-free survival benefit for both pre- and post-transplant patients of all risk types, reported Charlotte Pawlyn, PhD, of the Institute of Cancer Research at the University of London, and colleagues.

In this randomized trial, the investigators enrolled 1,056 newly diagnosed patients with multiple myeloma who were deemed eligible for transplantation. The patients were treated with either KCRD or an immunomodulatory drug triplet regimen of either cyclophosphamide, thalidomide, and dexamethasone or carfilzomib, lenalidomide, and dexamethasone, followed by an autologous stem cell transplantation.

At follow-up, the investigators found that patients who were treated with the four-drug regimen exhibited significantly longer 3-year progression-free survival rates than those patients treated with the triplet therapy (65.5% vs. 50.3%). Additionally, deeper responses to therapy were observed in the KCRD group compared with those in the triplet regimen groups for patients both pre- and post-therapy (P < .0001). Among both groups, the regimens appeared to be well tolerated, with “no significant” additional toxicity associated with the quadruplet regimen, the authors noted.

Dr. Pawlyn and colleagues also found that more patients treated with KCRD were able to undergo transplantation than those patients who received response-adapted induction. In addition, when considering those who completed transplantation alone, KCRD induction still led to longer progression-free survival rates.

Disclosure: The study authors’ disclosure information can be found at

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