Multiple Myeloma Coverage from Every Angle

Can a Novel Triplet Regimen Prevent Disease Progression in Patients With High-Risk Smoldering Myeloma?

By: Joseph Fanelli
Posted: Tuesday, November 9, 2021

For patients with high-risk smoldering myeloma, treatment with novel triplet regimens such as carfilzomib, lenalidomide, and dexamethasone (KRd) followed by lenalidomide maintenance therapy may prove to be effective and tolerable, potentially altering the natural history of the disease delaying the development of end-organ disease, according to findings presented in JAMA Oncology. However, according to Ola Landgren, MD, PhD, of the National Cancer Institute, Bethesda, Maryland, and the University of Miami, Florida, and colleagues, randomized clinical trials are needed to confirm their study findings and assess the balance between potency and safety.

“Patients with smoldering myeloma may be encouraged to enroll in trials evaluating novel multidrug combination therapies, including KRd followed by lenalidomide maintenance therapy,” the authors concluded.

In this phase II trial, the authors enrolled 54 patients with high-risk smoldering myeloma. The patients were treated with KRd, followed by lenalidomide maintenance therapy. They were evaluated at every cycle of therapy with KRd and every three cycles after that.

The authors found high rates of minimal residual disease–negative remission among the patients (70.4%), with a median sustained duration of 5.5 years. They calculated that the 8-year probability of being free from progression to multiple myeloma was 91.2% for those enrolled. No deaths occurred among the patients given the triplet.

Of the study patients, 21 experienced nonhematologic grade 3 adverse events (38.9%). The adverse events included thromboembolism, rash, and lung infection. No grade 4 events were reported.

Disclosure: For full disclosure of the study authors, visit

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