MULTIPLE MYELOMA (MM)- Key Abstracts:
Dr. Majhail selected the following abstracts for MM and provided his valuable insights.
- Durable Clinical Responses in Heavily Pretreated Patients with Relapsed/Refractory Multiple Myeloma: Updated Results from a Multicenter Study of bb2121 Anti-Bcma CAR T-Cell Therapy
In a multi-center phase 1 study of 21 patients with heavily treated relapsed/refractory multiple myeloma, chimeric antigen receptor T-cell (CAR-T) therapy targeted towards B-cell maturation antigen (BCMA) showed overall response rate of 89 percent. In addition, other pre-clinical and clinical studies presented at the meeting also reported significant activity of BCMA CAR-T infusions in this setting.
With these impressive responses, CAR-T treatments are now speeding into myeloma treatment space.
- Tackling Early Morbidity and Mortality in Myeloma (TEAMM): Assessing the Benefit of Antibiotic Prophylaxis and Its Effect on Healthcare Associated Infections in 977 Patients
Prophylactic use of levofloxacin 500 mg for 12 weeks significantly reduced febrile episodes and deaths compared to a placebo without increasing healthcare associated infections in a randomized, double-blind, phase 3 trial of antibiotic prophylaxis in adult patients with newly-diagnosed myeloma. Trimethoprim-sulfamethoxazole had an additive effect with levofloxacin on the primary endpoint. The rates of C. difficile, MRSA and ESBL-positive gram-negative bacteria were similar among the levofloxacin and placebo arms.
- Autologous Stem Cell Transplantation Versus Bortezomib-Melphalan-Prednisone for Newly Diagnosed Multiple Myeloma: Second Interim Analysis of the Phase 3 EMN02/HO95 Study
An interim analysis of a 1503 patient phase 3, multicenter, randomized trial showed that patients receiving 3-4 cycles of bortezomib-based induction followed by high dose melphalan and autologous stem cell transplantation achieved a deeper response, higher rates of minimal residual disease negativity, and better progression-free survival compared to patients receiving similar induction followed by intensification with bortezomib-melphalan-prednisone x 4 cycles (3-year progression-free survival 64 percent vs. 57 percent, P=0.002). Both arms received lenalidomide maintenance.
This study highlights the continued role of autologous transplantation as part of upfront therapy for myeloma in the novel agent era.
- Phase 3 Randomized Study of Daratumumab Plus Bortezomib, Melphalan, and Prednisone (D-VMP) Versus Bortezomib, Melphalan, and Prednisone (VMP) in Newly Diagnosed Multiple Myeloma (NDMM) Patients (Pts) Ineligible for Transplant (ALCYONE)
Although he was tasked with the lymphoma section, Dr. Matasar selected this MM study as one of the key abstracts from the conference. Here are his thoughts:
“The ALCYONE study represents another large randomized clinical trial with important findings. This study of 706 newly-diagnosed patients with multiple myeloma felt to be ineligible for high-dose melphalan tested a standard induction regimen of bortezomib, melphalan, and prednisone (VMP) to VMP plus daratumumab, an anti-CD38 monoclonal antibody approved for relapsed multiple myeloma.
At a median follow-up of 16 months, the hazard ratio for progression-free survival with D+VMP was 0.5, a benefit seen across all predefined patient subsets.
These data lend further support for inclusion of daratumumab in first-line therapy for patients with multiple myeloma ineligible for high-dose therapy.”
I also asked Dr. Majhail to comment on this study. Here is his commentary:
“In a randomized phase 3 trial of 706 multiple myeloma patients who were ineligible for high-dose chemotherapy and autologous transplantation due to older age or comorbidities, addition of Daratumumab to Bortezomib, Melphalan and Prednisone (D+VMP) doubled the odds of achieving progression-free survival compared to VMP alone (72 percent vs. 50 percent at 18 months). A larger proportion of patients in the D+VMP arm achieved deeper responses as evidenced by a higher rate of MRD negativity. The rates of treatment-related toxicities were comparable.
Although VMP is not commonly used in the US and Daratumumab is not approved for use as part of first line therapy, this study highlights the potential benefit of intensifying upfront treatment in patients who are not eligible for transplantation”