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Prashant Kapoor, MD, FACP


ASH 2023: Four-Drug vs Three-Drug Regimens Before and After ASCT in Myeloma

By: Joshua D. Madera, MD
Posted: Thursday, December 28, 2023

Adding the monoclonal antibody isatuximab to the standard combination therapy of carfilzomib, lenalidomide, and dexamethasone (KRd) may improve the rates of measurable residual disease (MRD) negativity in patients with autologous stem cell transplantation (ASCT)-eligible, newly diagnosed multiple myeloma, according to the results of the phase III randomized IsKia trial, presented at the 2023 American Society of Hematology (ASH) Annual Meeting & Exposition (Abstract 4). This benefit was also observed in patients with high-risk cytogenetic abnormalities, explained Francesca Gay, MD, PhD, of the University of Torino, Italy, and colleagues.

A total of 302 patients with transplantation-eligible, newly diagnosed multiple myeloma were randomly assigned to receive isatuximab plus KRd (n = 151) or KRd alone (n = 151). Patients given isatuximab plus KRd received it before initiation of ASCT and as consolidation therapy after ASCT. Patients were regularly monitored to assess their clinical status after treatment.

After the completion of consolidation therapy, the rates of MRD negativity were 67% and 48% for patients treated with isatuximab plus KRd and KRd alone (odds ratio = 2.29), respectively. A similar trend in the MRD negativity rate was observed in patients with high-risk cytogenetic abnormalities treated with isatuximab plus KRd (76%) or KRd alone (58%). Moreover, progression-free survival was similar between both treatment groups (95%). Common treatment-related adverse events reported by patients included neutropenia (37% with isatuximab plus KRd vs 22% with KRd alone), thrombocytopenia (15% vs 17%), infections (16% vs 12%), gastrointestinal events (7% vs 5%), vascular events (2% vs 7%), and cardiac events (1% vs 4%), respectively.

Disclosure: For full disclosures of the study authors, visit

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