Advertisement


Julie Côté, MD, on Multiple Myeloma: Real-World Results of Autologous Stem Cell Transplantation in Newly Diagnosed Patients

2022 ASH Annual Meeting and Exposition

Advertisement

Julie Côté, MD, of CHU de Québec–Université Laval, discusses findings from the Canadian Myeloma Research Group database, which showed that integrating bortezomib and lenalidomide into the autologous stem cell transplant (ASCT) sequence produces a median overall survival rate ≥ 10 years in most patients with newly diagnosed multiple myeloma. These observations highlight the contribution of post-ASCT maintenance, particularly lenalidomide given until disease progression, when used in multiple patient groups including those with and without high risk, as well as those requiring a second induction regimen (Abstract 117).



Transcript

Disclaimer: This video transcript has not been proofread or edited and may contain errors.
The standard of care for multiple myeloma patients with a new diagnosis and for patients that are transplant eligible in Canada, is to first to start with a bortezomib-based induction and then go with a high dose melphalan, an autologous stem cell transplant, followed by lenalidomide maintenance until progression. So, the aim of our study was really to look at the outcomes in details of this patient population in Canada, in the real world setting. So, using our national myeloma database from the C M R G, known as the Canadian Myeloma Research Group, all the patients who received an autologous stem cell transplant for multiple myeloma in the first line setting, from January 2007 to December 2021, were included. So, this gives us 3,800 patients approximately, and most of them received a bortezomib-based induction, mostly being CYBORD, in 72%. We had mostly single-transplant patients. Only 8% received tandem transplant, and it was mostly in high risk patients. 18% of the population were high risk. And what's interesting to see is that, overall with one single transplant, median PFS was around 35 months, and median overall survival was around 10 years. And median overall survival was around 10 years for approximately all subgroup patients, except in high-risk patients; so high-risk patients had inferior outcomes. For consolidation therapy, it's not root routinely available in Canada, so only a few patients received that kind of therapy, about 5%. It was mostly a regimen combining a ubiquitin and a proteasome inhibitor. Globally, consolidation leads to a better PFS, but with no significant gain on OS. For maintenance therapy, about half of our court received maintenance therapy, and it was mostly lenalidomide-based regimen. Maintenance therapy was leading to a significant benefit on PFS and OS, in all risk subgroups, although it does not completely abrogate the negative impact of high risk cytogenetics in the high risk patients. Globally, with the lenalidomide-based maintenance regimen, the PFS was around 4.5 years, and the overall survival around 13 years. As you can see, this real world data covers about 15 years in our court of timeline. And it really shows that the integration of bortezomib and lenalidomide in the transplant sequence, leads to an overall survival of about 10 years in most autologous stem cell transplant patient. It also highlights the beneficial contribution of lenalidomide mainstream therapy in patients without and with high risks, and also in patients receiving a second course of induction. Indeed, these patients had significantly inferior outcomes compared to those receiving only one induction regimen, but with maintenance therapy, outcomes would were comparable even though you received one or two induction regimen. So, this really highlights the importance of maintenance therapy in these subgroups. Right now, further analysis are ongoing, to look at relationship between treatment outcomes, patients characteristics, and these results will really serve as Canadian benchmarks to compare with newer approaches that are eventually coming.

Related Videos

Multiple Myeloma
Genomics/Genetics
Immunotherapy

Francesco Maura, MD, on Genomic Determinants of Resistance in Newly Diagnosed Multiple Myeloma Treated With Targeted Immunotherapy

Francesco Maura, MD, of the University of Miami, Sylvester Comprehensive Cancer Center, discusses his team’s findings in which they defined a comprehensive catalogue of genomic determinants of response to DKRd (carfilzomib, lenalidomide, dexamethasone) in newly diagnosed multiple myeloma. The researchers have identified a number of new genomic alterations that explain resistance to the agents currently used in combination regimens (Abstract 470).

 

Lymphoma

Eva Hoster, PhD, on Mantle Cell Lymphoma: Predictive Value of Minimal Residual Disease on Efficacy of Rituximab Maintenance

Eva Hoster, PhD, of Munich University, discusses results from the European MCL Elderly Trial, which confirmed the strong efficacy of rituximab maintenance in minimal residual disease (MRD)-negative patients with mantle cell lymphoma (MCL) after induction. Omitting maintenance based on MRD-negativity is thus discouraged. Considering the short time to progression, more effective treatment strategies should be explored in MRD-positive patients to improve long-term prognosis (Abstract 544).

Leukemia

Andrew Matthews, MD, on AML: Real-World Effectiveness of 7 + 3 Intensive Chemotherapy vs Venetoclax and a Hypomethylating Agent

Andrew Matthews, MD, of the Abramson Cancer Center, University of Pennsylvania, discusses findings from a large, multicenter study that showed superior outcomes with 7 + 3 chemotherapy (cytarabine continuously for 7 days, along with short infusions of an anthracycline on each of the first 3 days) vs venetoclax in patients with acute myeloid leukemia (AML). In this real-world data set, the 7 + 3 cohort outperformed historical benchmarks in overall survival and early mortality, perhaps reflecting improved later lines of therapy and patient selection. Prospective studies (such as NCT04801797) must confirm the superiority of intensive chemotherapy (Abstract 426).

 

Leukemia

Anand P. Jillella, MD, on Acute Promyelocytic Leukemia: A Simplified Patient Care Strategy to Decrease Early Deaths

Anand P. Jillella, MD, of Georgia Cancer Center at Augusta University, discusses results from the ECOG-ACRIN EA9131 Trial, which showed that using a simplified treatment algorithm and management recommendations made by a group of specialists, resulted in a dramatic improvement in 1-year survival of patients with acute promyelocytic leukemia (Abstract 421).

Leukemia
Issues in Oncology

Abdul Rahman Al Armashi, MD, on AML: Racial Disparities in Mortality Trends

Abdul Rahman Al Armashi, MD, of Seidman Cancer Center, Case Western University, University Hospitals Cleveland Medical Center, discusses a retrospective analysis, using a CDC database, in one of the largest subgroup-based racial population studies analyzing mortality trends in patients with acute myeloid leukemia (AML). Between 2000 and 2019, AML mortality was the highest in Whites and the lowest in American Indians or Alaska Natives. The highest rate of increase in mortality was seen in Asians or Pacific Islanders. Dr. Al Armashi talks about the many variables that might contribute to these inequalities (Abstract 600).

Advertisement

Advertisement




Advertisement