ASCT With Carfilzomib-Based Regimens in Newly Diagnosed Multiple Myeloma
Posted: Friday, July 9, 2021
The CARDAMON trial investigated the role of autologous stem cell transplantation (ASCT) using carfilzomib-based induction and maintenance regimens in patients with newly diagnosed multiple myeloma. Updated results demonstrated that in those given induction with carfilzomib/cyclophosphamide/dexamethasone (KCd) and carfilzomib maintenance, KCd consolidation was noninferior to ASCT. Of note, high-risk patients tended to have inferior outcomes, not apparently influenced by ASCT or consolidation randomization, according to Kwee Yong, MBBS, PhD, FRCP, FRCPath, of the University College Hospital, London. These findings were presented during the 2021 American Society of Clinical Oncology (ASCO) Annual Meeting (Abstract 8000).
Patients in the study received 4 x KCd induction (carfilzomib at 20/56 mg/m2 biweekly; cyclophosphamide at 500 mg on days 1, 8, and 15; and dexamethasone at 40 mg weekly) before 1:1 randomization to ASCT or 4 x KCd consolidation. All patients received 18 months of carfilzomib maintenance (56 mg/m2 on days 1, 8, and 15). Flow cytometric measurable residual disease (MRD; 10-5) was assessed after induction therapy, before maintenance therapy, and at 6 months of maintenance therapy.
In total, 281 patients were registered, with a median age of 59; a final group of 109 were randomly assigned to ASCT and 109, to KCd consolidation. The observed 2-year progression-free survival for the ASCT group was 75.5% versus 70.7% for the KCd consolidation group. It should be noted that MRD rates were higher in the ASCT group (53.1%) than in the group given KCd consolidation (35.8%) independent of genetics. As for toxicity, grade 3 and higher adverse events associated with induction therapy were infections (18.7%), hypertension (11.2%), anemia (10.4%), cardiac disorders (3.6%), vomiting (2.2%), fatigue (2.2%), and diarrhea (1.8%).
Disclosure: For full disclosures of the study authors, visit coi.asco.org.