Posted: Tuesday, July 19, 2022
Treatment following autologous stem cell transplantation (ASCT) remains a hot topic of clinical research in patients with multiple myeloma. To further the investigation, Dominik Dytfeld, MD, PhD, of the Poznan University of Medical Sciences, Poland, and colleagues conducted a study to determine the efficacy and safety of carfilzomib plus lenalidomide and dexamethasone (KRd) versus standard maintenance therapy with lenalidomide. The results of the multicenter phase III ATLAS trial, which were presented during the European Hematology Association (EHA) 2022 Congress (Abstract S175), suggested measurable residual disease (MRD)/risk-adapted post-ASCT extended treatment with this triplet combination may represent a new standard of care.
Patients with newly diagnosed multiple myeloma who underwent any induction therapy for up to 12 months followed by a single ASCT and achieved stable disease or better within 100 days were randomly assigned to receive KRd (n = 93) or lenalidomide (n = 87). After six cycles, 47% of the KRd arm and 29% of the lenalidomide arm achieved MRD negativity (P = .017). A total of 34 patients treated with KRd who achieved MRD negativity were eligible for de-escalation to lenalidomide alone after eight cycles. At a median follow-up of 33.8 months, 25% of the KRd arm and 44% of the lenalidomide arm experienced disease progression; the estimated median durations of progression-free survival were 59.0 and 41.4 months, respectively (log-rank P = .026).
A total of 90% of the KRd arm and 87% of the lenalidomide arm were alive at data cutoff; no treatment-related deaths were reported. According to the investigators, all-grade toxicities were generally comparable between the arms. The most commonly reported adverse events of grade 3 or higher and those of special interest were neutropenia (KRd: 47%; lenalidomide: 59%), thrombocytopenia (KRd: 13%; lenalidomide: 7%), infections (KRd: 15%; lenalidomide: 6%), cardiovascular toxicities (KRd: 4%; lenalidomide: 5%), and secondary malignancies (KRd: 2%; lenalidomide: 2%).