Carfilzomib, lenalidomide, and dexamethasone plus transplant in newly diagnosed multiple myeloma
Jagoda K Jasielec, Tadeusz Kubicki, Noopur Raje, Ravi Vij, Donna Reece, Jesus Berdeja, Benjamin A Derman, Cara A Rosenbaum, Paul Richardson, Sandeep Gurbuxani, Sarah Major, Brittany Wolfe, Andrew T Stefka, Leonor Stephens, Kathryn M Tinari, Tyler Hycner, Alexandra E Rojek, Dominik Dytfeld, Kent A Griffith, Todd M Zimmerman, Andrzej J Jakubowiak, Jagoda K Jasielec, Tadeusz Kubicki, Noopur Raje, Ravi Vij, Donna Reece, Jesus Berdeja, Benjamin A Derman, Cara A Rosenbaum, Paul Richardson, Sandeep Gurbuxani, Sarah Major, Brittany Wolfe, Andrew T Stefka, Leonor Stephens, Kathryn M Tinari, Tyler Hycner, Alexandra E Rojek, Dominik Dytfeld, Kent A Griffith, Todd M Zimmerman, Andrzej J Jakubowiak
Abstract
In this phase 2 multicenter study, we evaluated the incorporation of autologous stem cell transplantation (ASCT) into a carfilzomib-lenalidomide-dexamethasone (KRd) regimen for patients with newly diagnosed multiple myeloma (NDMM). Transplant-eligible patients with NDMM received 4 cycles of KRd induction, ASCT, 4 cycles of KRd consolidation, and 10 cycles of KRd maintenance. The primary end point was rate of stringent complete response (sCR) after 8 cycles of KRd with a predefined threshold of ≥50% to support further study. Seventy-six patients were enrolled with a median age of 59 years (range, 40-76 years), and 35.5% had high-risk cytogenetics. The primary end point was met, with an sCR rate of 60% after 8 cycles. Depth of response improved over time. On intent-to-treat (ITT), the sCR rate reached 76%. The rate of minimal residual disease (MRD) negativity using modified ITT was 70% according to next-generation sequencing (<10-5 sensitivity). After median follow-up of 56 months, 5-year progression-free survival (PFS) and overall survival (OS) rates were 72% and 84% for ITT, 85% and 91% for MRD-negative patients, and 57% and 72% for patients with high-risk cytogenetics. For high-risk patients who were MRD negative, 5-year rates were 77% and 81%. Grade 3 to 4 adverse events included neutropenia (34%), lymphopenia (32%), infection (22%), and cardiac events (3%). There was no grade 3 to 4 peripheral neuropathy. Patients with NDMM treated with KRd with ASCT achieved high rates of sCR and MRD-negative disease at the end of KRd consolidation. Extended KRd maintenance after consolidation contributed to deepening of responses and likely to prolonged PFS and OS. Safety and tolerability were manageable. This trial was registered at www.clinicaltrials.gov as #NCT01816971.
Conflict of interest statement
Conflict-of-interest disclosure: N.R. had a consulting or advisory role with Amgen, Bristol-Myers Squibb, Celgene, Janssen Oncology, Merck, Novartis, and Takeda and received research funding from AstraZeneca. R.V. received honoraria from, had a consulting or advisory role with, and received funding for travel, accommodations, and expenses from Bristol-Myers Squibb and Celgene. D.R. received honoraria from Amgen, Celgene, Janssen, and Takeda, had a consulting or advisory role with Amgen, Celgene, Janssen, Karyopharm Therapeutics, and Takeda, received research funding from Bristol-Myers Squibb, Celgene, Janssen, Merck, Otsuka, and Takeda, and provided expert testimony for Amgen and Celgene. J.B. had a consulting or advisory role with Amgen, BioClinica, Bristol-Myers Squibb, Celgene, Crispr Therapeutics, Janssen, Karyopharm Therapeutics, Kite Pharma, Legend Biotech, Prothena, Servier, and Takeda, and received research funding from AbbVie, Acetylon, Amgen, Bluebird Bio, Bristol-Myers Squibb, Celgene, Constellation, CURIS, Genentech/Roche, Glenmark, Janssen, Kesios, Eli Lilly, Novartis, Poseida Therapeutics, Sanofi, Takeda, Teva, and Vivolux. P.R. had a consulting or advisory role with Celgene, Janssen, Jazz Pharmaceuticals, Karyopharm Therapeutics, Oncopeptides, Sanofi, and Takeda and received research funding from Bristol-Myers Squibb, Celgene, Oncopeptides, and Takeda. D.D. received honoraria and research funding from Amgen and Celgene. T.M.Z. received honoraria from, had a consulting or advisory role with, and served on the speakers’ bureau for Celgene and Amgen. A.J.J. received honoraria from Amgen, Bristol-Myers Squibb, Celgene, and GlaxoSmithKline, was an investigator for AbbVie-sponsored clinical trials, Janssen, Karyopharm Therapeutics, Millennium Pharmaceuticals, Sanofi, Skyline Diagnostics, and Takeda, and had a consulting or advisory role with Amgen, Bristol-Myers Squibb, Celgene, and GlaxoSmithKline. The remaining authors declare no competing financial interests.
© 2020 by The American Society of Hematology.
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Source: PubMed