Treatment of Newly Diagnosed Myeloma (excluding t-cell redirection therapy)
Category: Treatment of Newly Diagnosed Myeloma (excluding t-cell redirection therapy)
DKRD vs. DVRD Induction Prior to Autologous Hematopoietic Stem Cell Transplantation for Multiple Myeloma
Oren Pasvolsky, MD
Assistant Professor
Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center
140 patients were included: 15 (11%) received DKRD induction and 125 (89%) received DVRD. Median age at autoHCT was 58 years for the DKRD cohort and 62 years for the DVRD cohort (p=0.09). 10 (67%) patients in the DKRD cohort had R2-ISS III/IV and 4 (27%) patients had high-risk cytogenetic abnormalities, compared to 58 (46%; p=0.18) and 64 (51%; p=0.10) in the DVRD cohort, respectively. Most patients in both groups received post-transplant maintenance (93% in the DKRD group and 82% in the DVRD group; p=0.47), mostly Len alone (57% and 70%, respectively).
Median time to neutrophil engraftment (ANC >500) after transplant was 12 days in both groups (p=0.75), and median time to platelet engraftment (plt >20K) was 12 days in the DKRD group and 13 days in the DVRD group (p=0.35).
The pre- and post-transplant response rates in the DKRD and DVRD groups were: ≥CR and ≥VGPR pre-transplant 40% and 100% vs. 26% (p=0.24) and 78% (p=0.08); at day 100 post-transplant: 60% and 100% vs. 52% (p=0.60) and 94% (p=1.00); at best post-transplant response: 73% and 100% vs. 77% (p=0.75) and 99% (p=1.00), respectively. Prior to transplant, 67% of the patients in the DKRD group achieved MRD negativity compared to 48% in the DVRD group (p=0.18); at best-post transplant response, 60% and 71% had MRD negativity, respectively (p=0.48).
After a median follow up of 18.7 (3.6-47.4) months, median PFS and OS were not reached for either the DKRD or DVRD groups. 1-year and 2-year PFS rates were both 100% for DKRD; 93% and 86% for DVRD. 1-year and 2-year OS rates were both 100% for DKRD; 98% and 93% for DVRD. There was no significant difference in either PFS (hazard ratio [95% CI] 1.62 [0.16-16.33], p=0.68) or OS (0.68 [0.03-16.35], p=0.81) between the two induction groups, using stabilized inverse probability weights.
Day100 and 1-year non-relapse mortality rates were 0% for both induction groups. All deaths were due to progression of MM. Three patients developed second primary malignancies, all in the DVRD group.
Conclusions:
To the best of our knowledge, this is the first study comparing the outcomes of MM patients receiving standard of care DKRD and DVRD induction followed by autoHCT. With the limitation that only 11% patients received DKRD, response rates and post-transplant survival outcomes were highly encouraging, and comparable, with both quadruplet regimens.