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Shaji K. Kumar, MD
Prashant Kapoor, MD, FACP
Shaji K. Kumar, MD
Prashant Kapoor, MD, FACP
Posted: Monday, June 6, 2022
In patients with newly diagnosed multiple myeloma, induction therapy with lenalidomide, bortezomib, and dexamethasone (RVd) with or without autologous stem cell transplantation (ASCT) and maintenance therapy with lenalidomide until disease progression reportedly resulted in the longest median duration of progression-free survival for each approach. Based on the primary results of the phase III DETERMINATION trial, which were presented by Paul G. Richardson, MD, of the Dana-Farber Cancer Institute, Boston, and colleagues during the 2022 American Society of Clinical Oncology (ASCO) Annual Meeting (Abstract LBA4), those who underwent ASCT seemed to reap the greatest benefit.
“These findings add to an overall positive trend for patients with multiple myeloma and provide information relevant to the optimal timing of stem cell transplant in this disease,” commented ASCO Chief Medical Officer and Executive Vice President Julie R. Gralow, MD, FACP, FASCO.
Transplant-eligible patients were randomly assigned to receive three cycles of RVd, stem cell mobilization, and then five more cycles of RVd (arm A; n = 357) or intravenous melphalan plus ASCT and two cycles of RVd (arm B; n = 365). Both arms underwent maintenance therapy with lenalidomide until disease progression or intolerance (n = 291 and 290, respectively).
The median duration of progression-free survival was 46.2 months in arm A and 67.6 months in arm B. The investigators reported the best response rates assessed to date in arms A and B, respectively: complete response or better in 52% and 62%; very good partial response or better in 79% and 83%; and partial response or better in 94% and 96%. In 251 evaluable patients, the rate of measurable residual disease negativity was 37.3% in arm A and 52.1% in arm B within 1 year of maintenance therapy. The 4-year overall survival rates did not seem to significantly differ between the arms (84% vs. 85%).
Treatment-related adverse events of grade 3 or higher were reported less frequently in arm A than in arm B (78% vs. 94%). Whole-genome sequencing, quality-of-life, and correlative analyses are ongoing.
Disclosure: For full disclosures of the study authors, visit coi.asco.org.
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