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Long-Term Outcomes With Triplet Induction and Risk-Adapted Maintenance Therapy for Newly Diagnosed Multiple Myeloma


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As reported by Joseph et al in the Journal of Clinical Oncology, follow-up in a large cohort of patients with newly diagnosed multiple myeloma indicates good long-term outcomes with consecutive treatment with lenalidomide/bortezomib/dexamethasone (RVD) induction therapy and risk-adapted maintenance therapy.

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Study Details

The study involved data on 1,000 consecutive patients at a single institution treated with RVD induction therapy from January 2007 until August 2016. Cytogenetic risk status was high in 25% of patients, standard in 63%, and unknown in 12%.

Among 977 evaluable patients, 809 were not offered deferred autologous stem cell transplantation (ASCT), with 751 receiving upfront transplantation and 609 receiving maintenance therapy (including lenalidomide in 76%, bortezomib in 5%, and a proteasome inhibitor and an immunomodulatory drug in 16%). A total of 168 patients were offered deferred ASCT, with 119 receiving maintenance (including lenalidomide in 95%, bortezomib in 1%, and a proteasome inhibitor and an immunomodulatory drug in 3%). 

Key Findings

Among all evaluable patients, the overall response rate was 97.1% after induction therapy and 98.5% after transplantation, with very good partial response or better achieved in 89.9%, and 33.3% achieving stringent complete response after transplantation at median follow-up of 67 months.

Median progression-free survival was 65 months among all patients, 40.3 months among high-risk patients, and 76.5 months among standard-risk patients. Median overall survival was 126.6 months among all patients, 78.2 months among high-risk patients, and not reached among standard-risk patients. Five-year overall survival among high-risk and standard-risk patients was 57% and 81%, and 10-year overall survival was 29% and 58%.

A very good partial response or better was achieved in 91% of patients who received maintenance therapy vs 74% of those not receiving maintenance (P < .0001), with a complete response or better achieved in 71% vs 57% (P < .0001). For patients receiving vs not receiving maintenance therapy, median progression-free survival was 65 vs 47 months (P = .005), and median overall survival was 129.84 vs 81.15 months (P < .0001).

The investigators concluded, “RVD is an induction regimen that delivers high response rates (very good partial response or better) in close to 90% of patients after transplantation, and risk-adapted maintenance can deliver unprecedented long-term outcomes. This study includes the largest cohort of patients treated with RVD reported to date with long follow-up and demonstrates the ability of three-drug induction regimens in patients with newly diagnosed multiple myeloma to result in a substantial survival benefit.”

Ajay K. Nooka, MD, MPH, of the Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, is the corresponding author for the Journal of Clinical Oncology article.

Disclosure: For full disclosures of the study authors, visit ascopubs.org.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
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