ASCO 2021: Durvalumab-Based Therapy for Ultra-High–Risk Newly Diagnosed Myeloma
Posted: Tuesday, June 22, 2021
According to Martin F. Kaiser, MD, of The Institute of Cancer Research (ICR), London, and colleagues, treatment with the anti-CD38 monoclonal antibody daratumumab plus cyclophosphamide, bortezomib, lenalidomide, and dexamethasone (CVRd) augmented high-dose melphalan, and autologous stem cell transplantation demonstrated high response rates in patients with ultra high–risk newly diagnosed multiple myeloma or plasma cell leukemia. Based on the multicenter OPTIMUM/MUKnine trial results, which was presented during the 2021 American Society of Clinical Oncology (ASCO) Annual Meeting (Abstract 8001), this combination therapy seemed to have comparable toxicity to other induction regimens.
A total of 107 patients were administered up to six cycles of induction therapy with daratumumab plus CVRd, high-dose melphalan, and autologous stem cell transplantation augmented with bortezomib. This regimen followed 18 cycles of consolidation therapy with daratumumab plus bortezomib, lenalidomide, and dexamethasone and maintenance therapy with daratumumab plus lenalidomide.
During induction therapy, two patients died due to infection. In the intention-to-treat population, the objective response rate was 94% after induction therapy. The objective response rate was 83% at 100 days after autologous stem cell transplantation in the intention-to-treat population. After induction therapy, 41% of patients achieved minimal residual disease (MRD) negativity, 40% were MRD-positive, and 19% were not evaluable. A total of 64% of patients achieved MRD negativity, 14% were MRD-positive, and 22% were not evaluable at 100 days after autologous stem cell transplantation. The response rate at 100 days after autologous stem cell transplantation was lower in patients with plasma cell leukemia.
Neutropenia (21%), thrombocytopenia (12%), and infection (12%) were among the most frequently reported grade 3 or 4 adverse events during induction therapy. Grade 3 neuropathy was reported in 3.7% of patients.
Disclosure: For full disclosures of the study authors, visit coi.asco.org.
