From the Nordic Myeloma Study Group: Update on Carfilzomib-Based Maintenance Therapy
Posted: Wednesday, October 27, 2021
The use of maintenance therapy with carfilzomib and dexamethasone in patients with multiple myeloma after salvage autologous stem cell transplantation (ASCT) led to an 8-month prolongation in the time to disease progression. Nina Gulbrandsen, MD, of Oslo University Hospital, Norway, published these phase II results on behalf of the Nordi Myeloma Study Group in the European Journal of Haematology.
This trial included 200 patients who had undergone upfront ASCT and subsequently had relapse of disease after 1 year. Patients received four cycles of carfilzomib, cyclophosphamide, and dexamethasone and then underwent salvage ASCT. At 2 months after salvage transplantation, 168 patients were randomly assigned to either observation or maintenance therapy with intravenous carfilzomib and oral dexamethasone.
The mean time to disease progression was 25.1 months in the group receiving carfilzomib/dexamethasone maintenance therapy and 16.7 months in the control group (hazard ratio = 0.46, P = .0004). This benefit in the time to disease progression was seen across nearly every patient subgroup. The median overall survival was not yet reached at the time of data cutoff (September 2019), whereas it was 44.5 months in the control group (hazard ratio = 0.47, P = .10). Improvement in response after salvage stem cell transplantation was seen in 52.4% of patients in the group receiving maintenance therapy, compared with 34.9% of patients in the control group (P = .003).
The most common hematologic adverse events during maintenance therapy were thrombocytopenia (29% in the experimental group, 21% in the control group) and anemia (58% vs. 44%). Other common adverse events in the experimental and control groups included hypertension (19% vs. 3%), dyspnea (24% vs. 11%), and bacterial infections (41% vs. 26%). Serious adverse events occurred in 30.5% of patients receiving carfilzomib/dexamethasone and 24.4% of patients in the control group; one patient given maintenance therapy died.
Disclosure: The study authors reported no conflicts of interest.
