Newly Diagnosed Multiple Myeloma: How Many Drugs Are Enough?

Presented by:
Shaji K. Kumar
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Volume/Issue:
Volume 19: Issue 11.5
Online Publication Date:
Nov 2021
DOI:
https://doi.org/10.6004/jnccn.2021.5104
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The treatment of multiple myeloma (MM) has evolved over the past decade, yet it remains a chronic disease. Several trials of 4-drug induction regimens have resulted in deepening of disease response. With the emergence of multidrug regimens, questions have arisen regarding the role of autologous stem cell transplant (ASCT) in MM therapy and available treatment options after ASCT. Clinicians have also continued to improve the efficacy of maintenance therapies. In transplant-ineligible patients, the phases of treatment are less distinct; however, several regimens have demonstrated efficacy in this clinical setting. Future research should focus on individualizing treatment approaches.

Disclosures: Dr. Kumar has disclosed receiving grant/research support and serving as a scientific advisor for AbbVie, Inc., Amgen Inc., Bristol-Myers Squibb Company, GlaxoSmithKline, Janssen Pharmaceutica Products, LP, Karyopharm Therapeutics, Regeneron Pharmaceuticals, Inc., Roche Laboratories, Inc., Sanofi-aventis US, and Takeda Pharmaceuticals North America, Inc; and receiving honoraria from Oncopeptides and BeiGene.

Correspondence: Shaji K. Kumar, MD, Division of Hematology, Mayo Clinic Cancer Center, 200 First Street SW, Rochester, MN 55905. Email: kumar.shaji@mayo.edu
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Print ISSN:
1540-1405
Online ISSN:
1540-1413
Publisher:
National Comprehensive Cancer Network
Cover Journal of the National Comprehensive Cancer Network
  • 1.

    Durie BGM, Hoering A, Abidi MH, et al. Bortezomib with lenalidomide and dexamethasone versus lenalidomide and dexamethasone alone in patients with newly diagnosed myeloma without intent for immediate autologous stem-cell transplant (SWOG S0777): a randomised, open-label, phase 3 trial. Lancet 2017;389:519–527.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 2.

    Kumar SK, Jacobus SJ, Cohen AD, et al. Carfilzomib or bortezomib in combination with lenalidomide and dexamethasone for patients with newly diagnosed multiple myeloma without intention for immediate autologous stem-cell transplantation (ENDURANCE): a multicentre, open-label, phase 3, randomised, controlled trial. Lancet Oncol 2020;21:1317–1330.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3.

    Moreau P, Attal M, Hulin C, et al. Bortezomib, thalidomide, and dexamethasone with or without daratumumab before and after autologous stem-cell transplantation for newly diagnosed multiple myeloma (CASSIOPEIA): a randomised, open-label, phase 3 study. Lancet 2019;394:29–38.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4.

    Voorhees PM, Kaufman JL, Laubach JP, et al. Depth of response to daratumumab, lenalidomide, bortezomib, and dexamethasone (RVd) improves over time in patients with transplant-eligible newly diagnosed multiple myeloma: Griffin study update [abstract]. Blood 2019;134(Suppl 1):Abstract 691.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5.

    Kapoor P, Gertz MA, Laplant B, et al. Phase 2 trial of daratumumab, ixazomib, lenalidomide and modified dose dexamethasone in patients with newly diagnosed multiple myeloma [abstract]. Blood 2019;134(Suppl 1):Abstract 864.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6.

    Costa LJ, Chhabra S, Godby KN, et al. Daratumumab, carfilzomib, lenalidomide and dexamethasone (Dara-KRd) induction, autologous transplantation and post-transplant, response-adapted, measurable residual disease (MRD)-based Dara-KRd consolidation in patients with newly diagnosed multiple myeloma [abstract]. Blood 2019;134(Suppl 1): Abstract 860.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7.

    Kaiser MF, Hall A, Walker K, et al. Depth of response and minimal residual disease status in ultra high-risk multiple myeloma and plasma cell leukemia treated with daratumumab, bortezomib, lenalidomide, cyclophosphamide and dexamethasone (Dara-CVRd): results of the UK Optimum/MUKnine trial [abstract]. J Clin Oncol 2021;39(Suppl 15):Abstract 8001.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8.

    Attal M, Lauwers-Cances V, Hulin C, et al. Autologous transplantation for multiple myeloma in the era of new drugs: a phase III study of the Intergroupe Francophone Du Myelome (IFM/DFCI 2009 trial) [abstract]. Blood 2015;126:Abstract 391.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9.

    Gay F, Mina R, Rota-Scalabrini D, et al. Carfilzomib-based induction/consolidation with or without autologous transplant (ASCT) followed by lenalidomide (R) or carfilzomib-lenalidomide (KR) maintenance: efficacy in high-risk patients [abstract]. J Clin Oncol 2021;39(Suppl):Abstract 8002.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10.

    Hari P, Pasquini MC, Stadtmauer EA, et al. Long-term follow-up of BMT CTN 0702 (STaMINA) of postautologous hematopoietic cell transplantation (AutoHCT) strategies in the upfront treatment of multiple myeloma (MM) [abstract]. J Clin Oncol 2020;38(Suppl):Abstract 8506.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11.

    Cavo M, Gay FM, Patriarca F, et al. Double autologous stem cell transplantation significantly prolongs progression-free survival and overall survival in comparison with single autotransplantation in newly diagnosed multiple myeloma: an analysis of phase 3 EMN02/HO95 study [abstract]. Blood 2017;130(Suppl 1):Abstract 401.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12.

    McCarthy PL, Holstein SA, Petrucci MT, et al. Lenalidomide maintenance after autologous stem-cell transplantation in newly diagnosed multiple myeloma: a meta-analysis. J Clin Oncol 2017;35:3279–3289.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13.

    Dimopoulos MA, Gay F, Schjesvold F, et al. Oral ixazomib maintenance following autologous stem cell transplantation (TOURMALINE-MM3): a double-blind, randomised, placebo-controlled phase 3 trial. Lancet 2019;393:253–264.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14.

    O’Donnell EK, Laubach JP, Yee AJ, et al. A phase 2 study of modified lenalidomide, bortezomib and dexamethasone in transplant-ineligible multiple myeloma. Br J Haematol 2018;182:222–230.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15.

    Facon T, Kumar SK, Plesner T, et al. Overall survival results with daratumumab, lenalidomide, and dexamethasone versus lenalidomide and dexamethasone in transplant-ineligible newly diagnosed multiple myeloma: phase 3 MAIA study [abstract]. Presented at the European Hematology Association (EHA) Congress 2021; June 9–17, 2021. Abstract LB1901.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16.

    Mateos MV, Cavo M, Bladé J, et al. Daratumumab plus bortezomib, melphalan, and prednisone versus bortezomib, melphalan, and prednisone in patients with transplant-ineligible newly diagnosed multiple myeloma: overall survival in ALCYONE [abstract]. Blood 2019;134(Suppl 1): Abstract 859.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 17.

    Facon T, Venner CP, Bahlis NJ, et al. Oral ixazomib, lenalidomide, and dexamethasone for transplant-ineligible patients with newly diagnosed multiple myeloma. Blood 2021;137:3616–3628.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
Copyright:
Copyright © 2021 by the National Comprehensive Cancer Network 2021
Page Numbers:
4
Article Category:
Research Article
Print Publication Date:
Nov 2021
Online Publication Date:
Nov 2021

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