Multiple Myeloma Coverage from Every Angle

Ixazomib-Based Combination for High-Risk Smoldering Multiple Myeloma

By: Cordi Craig
Posted: Friday, January 10, 2020

The triple-drug combination of ixazomib, lenalidomide, and dexamethasone is a well-tolerated and effective early therapeutic intervention for patients with high-risk smoldering multiple myeloma, according to a phase II trial presented at the 2019 American Society of Hematology (ASH) Annual Meeting & Exposition in Orlando, Florida (Abstract 580). Mark Bustoros, MD, of the Dana-Farber Cancer Institute, Boston, and colleagues reported that the results support previous studies and indicate high response rates and a manageable toxicity profile.

The research team treated 53 patients with high-risk smoldering multiple myeloma with ixazomib, lenalidomide, and dexamethasone. Patients underwent baseline assessments, including bone marrow samples for minimal residual disease testing, whole-exome sequencing, and RNA sequencing of plasma and bone marrow cells. The median follow-up was 14.4 months.

The overall response rate of those who completed at least a cycle of treatment (n = 45) was 91.1%. Of those patients, 14 had complete responses, 9 had very good partial responses, 18 had partial responses, and 4 had minimal responses. Hypertension (6.3%), hypophosphatemia (4.2%), and rash (4.2%) were the most commonly reported grade 3 adverse events. Grade 4 toxicities included thrombocytopenia (4.4%), neutropenia (4.4%), and hyperglycemia (2.2%). As of July 2019, none of the patients’ disease progressed to multiple myeloma.

For patients who achieved complete responses and very good partial responses, the researchers plan to perform minimal residual disease testing using next-generation sequencing. Longer follow-up studies for disease outcomes are also ongoing.

Disclosure: For full disclosures of the study authors, visit

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