Curative Strategy for High-Risk Smoldering Myeloma
A novel curative approach led to durable responses in patients with high-risk smoldering multiple myeloma, according to research presented by Maria-Victoria Mateos, MD, PhD, of the University Hospital of Salamanca, Spain, and colleagues, at the 2017 American Society of Hematology (ASH) Annual Meeting & Exposition (Abstract 402).
The strategy includes carfilzomib, lenalidomide, and dexamethasone (KRd) as induction therapy followed by high-dose therapy/autologous stem cell transplantation (SCT), consolidation with KRd, and maintenance with lenalidomide and dexamethasone. The Spanish Myeloma Group previously demonstrated that early treatment with lenalidomide plus dexamethasone in patients with this precancerous form of myeloma who are at high risk of disease progression resulted in a significant benefit in terms of progression to multiple myeloma and overall survival.
“Although longer follow-up is required, this ‘curative strategy for high-risk smoldering multiple myeloma’ seems to be encouraging,” the investigators reported. “The depth of response improved along with the duration of treatment, achieving up to 85% complete response or better in patients who completed induction, autologous SCT, and consolidation, with an acceptable safety profile.”
In this single-arm, phase II trial, 90 transplant-eligible patients with smoldering myeloma who were at high risk of disease progression received 6 weeks of induction therapy with KRd. This treatment was followed by melphalan and autologous SCT as intensification therapy, two consolidation cycles with carfilzomib, lenalidomide and dexamethasone, and maintenance with lenalidomide plus dexamethasone for up to 2 years. After a median follow-up of 13 months, 98% of patients remain free of disease progression.