Continuous Treatment Improves Outcomes in Patients With Multiple Myeloma Not Eligible for ASCT

11/18/17

A recent study found that continued therapy with a combination regimen until disease progression improves outcomes in patients with newly diagnosed multiple myeloma who are not eligible for autologous stem cell transplant (ASCT).

The study’s findings will be presented at the 59th Annual American Society of Hematology (ASH) Meeting (December 9-12, 2017; Atlanta, GA).

Immunotherapy agents have shown effectiveness in treating newly diagnosed multiple myeloma. However, the optimal duration of therapy has yet to be decided.

Charlotte Pawlyn, BA, PhD, The Institute of Cancer Research (London, England), and colleagues conducted a phase III study (NCRI Myeloma XI) to compare multiple triplet regimens in patients with newly diagnosed multiple myeloma who were ineligible for ASCT. A total of 1852 patients were randomly assigned to receive either cyclophosphamide, lenalidomide, and dexamethasone (CRD; n = 928) or cyclophosphamide, thalidomide, and dexamethasone (CTD; n = 924). Patients received a median of six induction cycles in both arms.

At maximum response, a maintenance randomization compared lenalidomide until disease progression versus observation. A total of 836 patients (45%) entered the maintenance arm.

Results of the study showed that patients in the CRD arm followed by lenalidomide maintenance benefited from the most improved outcomes. Median progression-free survival for those receiving CRD plus lenalidomide, CTD plus lenalidomide, CRD plus observation, and CTD plus observation were 34.2 months, 31.1 months, 18.1 months, and 16.4 months, respectively.

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Furthermore, CRD was better tolerated with fewer dose modifications and fewer patients stopping therapy due to unacceptable toxicity compared with CTD. Those receiving CTD exhibited higher rates of peripheral sensory neuropathy and constipation, whereas those receiving CRD had higher rates of neutropenia.

Researchers concluded that continuing treatment with cyclophosphamide, lenalidomide, and dexamethasone until disease progression is beneficial for patients with newly diagnosed multiple myeloma who are ineligible for ASCT. “Novel approaches to reducing toxicity and delivering induction and ongoing therapy to very elderly patients are warranted,” they wrote.—Zachary Bessette