Skip to main content
IMS Events Main banner

    Treatment of Newly Diagnosed Myeloma (excluding t-cell redirection therapy)

    Category: Treatment of Newly Diagnosed Myeloma (excluding t-cell redirection therapy)

    Importance of re-induction in patients with transplant eligible multiple myeloma refractory to frontline therapy.

    (PA-387) Importance of Re-induction in Patients with Transplant Eligible Multiple Myeloma Refractory to Frontline Therapy

    Thursday, September 18, 2025

    Introduction:      Approximately 10% of transplant eligible multiple myeloma (MM) patients are refractory to induction therapy. The role and outcomes of re-induction therapy for such patients remain unclear. Strategies range from proceeding directly to autologous stem cell transplant (ASCT), or to pursuing a second induction to improve disease control prior to ASCT. We aim to describe the management and outcomes of primary refractory patients in British Columbia, which will serve as a benchmark for further strategies to optimize outcomes in this high-risk group. 

    Methods:   Patients initiating treatment between January 1, 2015 and September 1, 2022, were included. We identified patients who failed to achieve at least a partial response (PR) or progressed during induction therapy. Survival endpoints were progression free survival (PFS) and overall survival (OS), which were measured both from the time of initial therapy and from ASCT to account for lead time bias introduced with re-induction therapy. We compared outcomes between patients who received re-induction prior to ASCT to patients who did not receive re-induction. 

    Results:   422 transplant patients were identified. The cohort for analysis consisted of 39 primary refractory patients (9%). 36% failed to achieve PR and 64% progressed during initial induction. 33% of the patients had high-risk cytogenetics. Cyclophosphamide, bortezomib and dexamethasone (CyBorD) was the frontline induction regimen used in 97%. 64% of patients received re-induction prior to ASCT. Regimens included bortezomib, lenalidomide and cyclophosphamide (VRd) in 60%, and daratumumab, lenalidomide, and dexamethasone in 24%.  Of those who received re-induction therapy, the overall response rate was 68% prior to ASCT. The median PFS from initial therapy was 30.2 months. The median PFS from ASCT was 24.5 months. Comparing patients who received re-induction vs those who did not, the median PFS was 38.4 vs 8.5 months respectively (p = 0.001). This was similar when PFS was measured from ASCT (29.4 months vs 3.3 months respectively, p = 0.001). The median OS was 42.8 months. The median OS from ASCT was 38.0 months. Comparing patients who received re-induction vs those who did not, the median OS was 57.3 months vs 17.4 months, p = 0.004. A similar trend was seen when OS was measured from time of ASCT (51.1 months vs 12.4 months, p = 0.009).  

    Conclusions:   Our findings confirm the poor survival outcomes in primary refractory MM. Re-induction improved PFS and OS regardless of whether measured at the time of induction or from time of ASCT. This is likely related to improved disease control pre-ASCT. Overall, re-induction strategies should be employed when these high-risk situations are encountered prior to ASCT. While the series is enriched with patients transitioning from CyBorD to VRd, further updates to the dataset will be needed to examine re-induction strategies with more contemporary frontline strategies like VRd and anti-CD3b monoclonal antibody containing regimens.