Multiple Myeloma Coverage from Every Angle

ASH 2018: Transplant Versus Continuous Lenalidomide-Based Therapy for Relapsed Multiple Myeloma

By: Sarah Campen, PharmD
Posted: Monday, December 3, 2018

In patients with relapsed multiple myeloma, salvage high-dose chemotherapy followed by autologous stem cell transplantation appears to have similar efficacy compared with continuous lenalidomide-based therapy, according to the results of a trial presented at the 2018 American Society of Hematology (ASH) Annual Meeting & Exposition in San Diego (Abstract 253). However, as Hartmut Goldschmidt, MD, of the University Hospital Heidelberg, Germany, and colleagues noted, almost 30% of patients in the transplant arm did not receive the planned treatment.

“The number of patients not undergoing salvage [high-dose chemotherapy/autologous stem cell transplantation] and the approval of more active [lenalidomide/dexamethasone]-based triplet regimens after the initiation of this trial prevents definite conclusions” on the role of salvage chemotherapy and transplant, explained the researchers. Exploratory landmark analyses revealed a trend toward superior progression-free survival (23.1 vs. 20.1 months) and significantly superior overall survival (not reached vs. 57 months) in the transplant versus maintenance arm; however, the response rate and progression-free survival based on the overall trial population did not significantly differ.

Treatment in the transplant arm (n = 139) included re-induction with 3 rounds of lenalidomide plus dexamethasone, high-dose melphalan, autologous stem cell transplantation, and lenalidomide maintenance until disease progression. Patients in the no-transplant arm (n = 138) received continuous lenalidomide and dexamethasone until disease progression. More than 90% of patients in both arms had 1 prior therapy line, and there was a significantly higher incidence of high-risk cytogenetic aberrations in the transplant arm (42.9% vs. 31.6%). As for safety, higher rates of leukopenia, neutropenia, grade ≥ 3 thrombocytopenia, and grade ≥ 3 mucositis were seen in the transplant arm.

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