Lenalidomide-Based Maintenance after Autologous Hematopoietic Stem Cell Transplantation for Patients with High-Risk Multiple Myeloma

Pasvolsky, Oren; Milton, Denái R.; Rauf, Mikael; Tanner, Mark R.; Bashir, Qaiser; Srour, Samer A.; Tang, Guilin; Saini, Neeraj; Ramdial, Jeremy; Masood, Adeel; Nieto, Yago; Lee, Hans C.; Patel, Krina; Kebriaei, Partow; Thomas, Sheeba K.; Weber, Donna M.; Orłowski, Robert Z.; Shpall, Elizabeth J.; Champlin, Richard E.; Qazilbash, Muzaffar H.

doi:10.1016/j.jtct.2022.07.028

Cited by 6 publications

(6 citation statements)

References 18 publications

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“…A recent analysis by our group showed a lack of benefit for Len-based combinations as maintenance for HRMM patients, although there was a trend toward a longer PFS in patients with high-risk cytogenetic abnormalities other than 1q gain or amplification. 24 Patients in our study that received KRD induction had better PFS (HR 0.53), compared with other induction regimens, mostly VRD. The ENDURANCE trial did not show a difference in survival outcomes between patients who received induction with either VRD or KRD.…”

Section: Joseph Et Al Described Outcomes Of 1000 MM Patients Treatedmentioning

confidence: 63%

“…An ongoing randomized trial is examining the addition of daratumumab to Len maintenance (http://clinicaltrials.gov Identifier: NCT04071457). A recent analysis by our group showed a lack of benefit for Len‐based combinations as maintenance for HRMM patients, although there was a trend toward a longer PFS in patients with high‐risk cytogenetic abnormalities other than 1q gain or amplification 24 …”

Section: Discussionmentioning

confidence: 89%

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Single‐agent lenalidomide maintenance after upfront autologous stem cell transplant for newly diagnosed multiple myeloma: The MD Anderson experience

et al. 2023

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The optimal duration of lenalidomide (Len) maintenance for patients with multiple myeloma (MM) after autologous stem cell transplantation (autoHCT) is unknown. We conducted a retrospective single‐center analysis of adult MM patients that received upfront autoHCT between 2005 and 2021, followed by single‐agent Len maintenance. A total of 1167 patients were included with a median age of 61.4 (range 25.4–82.3) years, and high‐risk chromosomal abnormalities in 19%. Median duration of maintenance was 22.3 (range 0.03–139.6) months. After a median follow‐up of 47.9 (range 2.9–171.7) months, median PFS and OS for the entire cohort were 56.6 (95% CI 48.2–61.4) months and 111.3 (95% CI 101.7–121.5) months, respectively. In MVA, high‐risk cytogenetics was associated with a worse PFS (HR 1.91) and OS (HR 1.73) (p < .001 for both). Use of KRD induction and achievement of MRD‐negative ≥ VGPR before autoHCT were associated with an improved PFS (HR 0.53 and HR 0.57, respectively; p < .001 for both). Longer maintenance duration, even with a 5‐year cutoff, was associated with superior PFS and OS (HR 0.17 and 0.12, respectively; p < .001 for both). A total of 106 patients (9%) developed a second primary malignancy (SPM), mostly solid tumors (39%) and myeloid malignancies (30%). Longer maintenance duration was associated with a higher risk of SPM, reaching statistical significance after >2 years (odds ratio 2.25; p < .001). In conclusion, outcomes with Len maintenance were comparable to those reported in large clinical trials. Longer duration of maintenance, even beyond 5 years, was associated with improved survival.

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Section: Joseph Et Al Described Outcomes Of 1000 MM Patients Treatedmentioning

confidence: 63%

Section: Discussionmentioning

confidence: 89%

Single‐agent lenalidomide maintenance after upfront autologous stem cell transplant for newly diagnosed multiple myeloma: The MD Anderson experience

et al. 2023

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“…A retrospective analysis assessed whether more intensive lenalidomide‐based combination maintenance strategies improved PFS compared to lenalidomide alone. Lenalidomide combinations did not significantly improve PFS but a trend towards improved PFS was seen in the lenalidomide combination group, except for those with gain 1q 63 …”

Section: Role Of Maintenance: Conventional Agentsmentioning

confidence: 80%

“…Lenalidomide combinations did not significantly improve PFS but a trend towards improved PFS was seen in the lenalidomide combination group, except for those with gain 1q. 63 The OPTIMUM/MUK nine trial has also evaluated intensive induction in an ultra-high-risk MM group with two or more HRCA or primary plasma cell leukaemia. 64 A total of 107 patients across the UK received Dara-CVRd induction, Vel-Mel augmented AHCT, followed by 18 cycles of Dara-VR-based consolidation and monthly Dara-R maintenance until progression.…”

Section: Risk-based Maintenance Strategiesmentioning

confidence: 99%

The role of maintenance therapy following autologous stem cell transplantation in newly diagnosed multiple myeloma: Considerations on behalf of the Chronic Malignancies Working Party of the EBMT

Hwang,

Hayden,

Pawlyn

et al. 2024

Br J Haematol

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SummaryRecent treatment advancements in multiple myeloma have led to significant improvements in patient outcomes. Maintenance therapy following autologous haematopoietic stem cell transplantation (AHCT) is now standard of care and has been demonstrated to prolong and deepen treatment responses. Currently, lenalidomide remains the single agent that has been approved for maintenance post‐AHCT in Europe and the USA which, if tolerated, is continued until disease progression. The treatment landscape is rapidly expanding however, and the optimal personalised maintenance approach for a patient is becoming more complex. Treatment outcomes for patients with high‐risk disease remain poor and choice of maintenance in this population also remains unclear. This review article evaluates up‐to‐date literature regarding established maintenance approaches. It further analyses ongoing studies exploring maintenance regimens using combination and novel agents, approaches to maintenance in patients with cytogenetic high‐risk disease and minimal residual disease response‐adapted strategies that reflect the current evolving treatment paradigm.

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“…Therefore, both the International Myeloma Working Group (IMWG) and Mayo Stratification of Myeloma and Risk-Adapted Therapy (mSMART) 3.0 have taken 1q21 + as an important reference factor for risk stratification (20)(21)(22). In recent years, the introduction of autologous hematopoietic stem cell transplantation (ASCT), immunomodulatory drugs (IMiDs), proteasome inhibitors (PIs), and an anti-CD38 monoclonal antibody have greatly improved the outcomes of patients with MM (23)(24)(25)(26). However, the overall survival (OS) of patients with MM and 1q21 + remains to be improved (27,28).…”

Section: Introductionmentioning

confidence: 99%

The numerous facets of 1q21⁺ in multiple myeloma: Pathogenesis, clinicopathological features, prognosis and clinical progress (Review)

Liu,

Xie,

et al. 2024

Oncol Lett

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Multiple myeloma (MM) is a malignant neoplasm characterized by the clonal proliferation of abnormal plasma cells (PCs) in the bone marrow and recurrent cytogenetic abnormalities. The incidence of MM worldwide is on the rise. 1q21 + has been found in ~30-40% of newly diagnosed MM (NDMM) patients.1q21 + is associated with the pathophysiological mechanisms of disease progression and drug resistance in MM. In the present review, the pathogenesis and clinicopathological features of MM patients with 1q21 + were studied, the key data of 1q21 + on the prognosis of MM patients were summarized, and the clinical treatment significance of MM patients with 1q21 + was clarified, in order to provide reference for clinicians to develop treatment strategies targeting 1q21 + . Contents 1. Introduction 2. Pathogenesis and clinicopathological features of 1q21 + in patients with MM 3. Impact of 1q21 + on prognosis 4. Treatment of MM patients with 1q21 + 5. Conclusions

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Lenalidomide-Based Maintenance after Autologous Hematopoietic Stem Cell Transplantation for Patients with High-Risk Multiple Myeloma

Cited by 6 publications

References 18 publications

Single‐agent lenalidomide maintenance after upfront autologous stem cell transplant for newly diagnosed multiple myeloma: The MD Anderson experience

Single‐agent lenalidomide maintenance after upfront autologous stem cell transplant for newly diagnosed multiple myeloma: The MD Anderson experience

The role of maintenance therapy following autologous stem cell transplantation in newly diagnosed multiple myeloma: Considerations on behalf of the Chronic Malignancies Working Party of the EBMT

The numerous facets of 1q21⁺ in multiple myeloma: Pathogenesis, clinicopathological features, prognosis and clinical progress (Review)

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Lenalidomide-Based Maintenance after Autologous Hematopoietic Stem Cell Transplantation for Patients with High-Risk Multiple Myeloma

Cited by 6 publications

References 18 publications

Single‐agent lenalidomide maintenance after upfront autologous stem cell transplant for newly diagnosed multiple myeloma: The MD Anderson experience

Single‐agent lenalidomide maintenance after upfront autologous stem cell transplant for newly diagnosed multiple myeloma: The MD Anderson experience

The role of maintenance therapy following autologous stem cell transplantation in newly diagnosed multiple myeloma: Considerations on behalf of the Chronic Malignancies Working Party of the EBMT

The numerous facets of 1q21+ in multiple myeloma: Pathogenesis, clinicopathological features, prognosis and clinical progress (Review)

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The numerous facets of 1q21⁺ in multiple myeloma: Pathogenesis, clinicopathological features, prognosis and clinical progress (Review)