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Prashant Kapoor, MD, FACP


ASH 2023: MRD Negativity With Triplet Therapy in Transplantation-Ineligible Patients With Myeloma

By: Amanda E. Ruffino, BA
Posted: Thursday, December 14, 2023

In a phase III, randomized, multicenter study (EMN20), Sara Bringhen, MD, PhD, of Azienda Ospedaliero-Universitaria Città della Salute e della Scienza, Torino, Italy, and colleagues compared lenalidomide plus dexamethasone (Rd) with and without weekly carfilzomib (KRd) in newly diagnosed, autologous stem cell transplantation (SCT)-ineligible patients with multiple myeloma. The primary aim was to enhance measurable residual disease (MRD) negativity and progression-free survival. Among 82 randomly assigned patients, 78.6% of those given KRd and 45.0% of those given Rd are still under treatment, and median progression-free survival was not reached with the triple vs 20.9 months with the doublet. The 2-year overall survival favored KRd (89%) over Rd (74%). The investigators’ findings were presented at the American Society of Hematology (ASH) Annual Meeting & Exposition (Abstract 205).

According to the investigators, KRd achieved an “unexpected” high MRD negativity rate, with 50% at 1 year, 55% at 2 years, and 38% sustaining MRD negativity at 2 years. In contrast, no patients receiving Rd achieved MRD negativity. This higher MRD negativity rate correlated with prolonged progression-free survival, suggesting clinical significance, they noted.

Toxicities were reported to be manageable, with grade 3 or 4 adverse events in the KRd arm including neutropenia, thrombocytopenia, cardiac events, infection, and hypertension. Rd had a distinct adverse event profile, primarily involving neutropenia and dermatologic events.

Disclosure: For the study authors’ full disclosures, visit

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