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. ZimmermanAndrzej J. Jakubowiak

Research output: Contribution to journalArticlepeer-review

32 Scopus citations

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 (<1025 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.

Original languageEnglish
Pages (from-to)2513-2523
Number of pages11
JournalBlood
Volume136
Issue number22
DOIs
StatePublished - Nov 26 2020

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