Long-Term Strategy Required for Newly Diagnosed Multiple Myeloma
Posted: Tuesday, October 19, 2021
Over the past decade, clinicians have tried to improve upon the treatment of newly diagnosed multiple myeloma; however, according to Shaji K. Kumar, MD, Professor of Medicine, Mayo Clinic Cancer Center, Rochester, Minnesota, it remains a chronic disease. The current and emerging therapeutic approaches to this particular group of patients with myeloma were discussed in detail in his presentation during the NCCN 2021 Virtual Congress: Hematologic Malignancies.
“We still don’t know whether we should be using three drugs or four drugs [for induction therapy],” Dr. Kumar commented. “[However], the data with the four-drug combinations clearly show that it can give us deeper responses, which we know can translate to better outcomes.”
With the emergence of multidrug regimens, questions have arisen regarding the role of autologous stem cell transplantation for those with newly diagnosed myeloma (ASCT). In a randomized trial, patients who underwent ASCT seemed to derive a progression-free survival benefit; thus, according to Dr. Kumar, it remains an important part of therapy. There are three treatment options after ASCT: consolidation therapy with tandem ASCT, nontransplant consolidation therapy, or maintenance therapy; based on the results of clinical trials, Dr. Kumar noted there is probably a role for tandem ASCT in high-risk patients.
According to Dr. Kumar, patients treated with lenalidomide, ixazomib, or daratumumab maintenance therapy seemed to experience improved outcomes. Maintenance therapy with lenalidomide alone may be insufficient in those with high-risk disease; however, data from a randomized trial support the use of lenalidomide plus a proteasome inhibitor.
Transplant-eligible patients are usually administered induction therapy, consolidation therapy with ASCT, and maintenance therapy with one or more drugs. In transplant-ineligible patients, the phases of treatment are not as clear; however, several regimens have demonstrated efficacy in this clinical setting.
“Clearly, there is a lot more that needs to be done in terms of individualizing the treatment approach,” Dr. Kumar concluded.
Disclosure: For full disclosure of study authors, nccn.org.
