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Shaji K. Kumar, MD
Prashant Kapoor, MD, FACP
Shaji K. Kumar, MD
Prashant Kapoor, MD, FACP
Posted: Friday, December 16, 2022
Current efforts aimed at reducing the progression of high-risk smoldering myeloma to multiple myeloma may have identified a potentially effective treatment strategy, according to a presentation given at the 2022 American Society for Hematology (ASH) Annual Meeting and Exposition (Abstract 118). This study demonstrated a 23% measurable residual disease (MRD)-negative status for patients 2 years after the completion of an intensive treatment regimen, explained Maria-Victoria Mateos, MD, of Hospital Universitario de Salamanca, Spain, and colleagues.
From 2015 to 2017, a total of 90 patients with smoldering myeloma were included in the study. All patients were classified as being at high risk for disease progression. Patients were initially given induction therapy with 36 mg/m2 of carfilzomib twice weekly, 25 mg of lenalidomide on days 1 to 21 of treatment, and 40 mg of dexamethasone weekly over a 4-week period. Subsequently, they received intensification therapy with 200 mg/m2 of melphalan and autologous stem cell transplantation (ASCT). This was followed by consolidation therapy with two cycles of carfilzomib, lenalidomide, and dexamethasone. Lastly, patients were kept on maintenance therapy with 10 mg of lenalidomide and 20 mg of dexamethasone weekly for a maximum of 2 years. If patients discontinued maintenance therapy and demonstrated signs of biologic disease progression, they were eligible for rescue therapy with daratumumab, pomalidomide, and dexamethasone.
At 65.8 months after beginning treatment, 94% of patients were alive and progression-free. Six patients developed multiple myeloma, and seven patients died of their disease. In addition, 31 patients demonstrated biologic disease progression; they had a 72% progression-free survival rate. Furthermore, rate of MRD negativity of 40%, 63%, 68%, and 52% were identified at the postinduction, postintensification, postconsolidation, and postmaintenance phases of treatment. Moreover, 25.6% of patients maintained an MRD-negative status 4 years after completing ASCT.
Disclosure: For full disclosures of the study authors, visit ash.confex.com.
2022 ASH Annual Meeting and Exposition
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