Outcomes of Daratumumab, Pomalidomide, and Dexamethasone, Followed by High-dose Chemotherapy and Autologous Stem Cell Transplantation, in Patients With Relapsed/Refractory Multiple Myeloma

Abdallah, Al‐Ola; Mohyuddin, Ghulam Rehman; Mahmoudjafari, Zahra; Atrash, Shebli; Kawsar, Hameem I.; Sigle, Monia; Shune, Leyla; McGuirk, Joseph P.; Ganguly, Siddhartha

doi:10.1016/j.clml.2020.08.026

Cited by 3 publications

(3 citation statements)

References 38 publications

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“…In an analysis of the randomized Phase 3 study ASPIRE in patients with RRMM, the ORR after KRd therapy in patients with late relapse (after >1 year) was 89% [ 28 ]. Other clinical and observational studies have reported ORRs of 84–95% in patients with RRMM after carfilzomib-based or daratumumab-based combination therapy in second line or third line [ 22 , 28 – 30 ], and of 96–100% after bortezomib-based or daratumumab-based combination re-induction therapy and salvage ASCT [ 15 , 16 ]. Our results demonstrated that after re-induction and SCT, 6% and 16% of patients, respectively, achieved a CR or better, and 52% and 77% had a VGPR or better (with most patients treated with KRd as re-induction).…”

Section: Discussionmentioning

confidence: 99%

“…Our results demonstrated that after re-induction and SCT, 6% and 16% of patients, respectively, achieved a CR or better, and 52% and 77% had a VGPR or better (with most patients treated with KRd as re-induction). After re-induction (with mainly daratumumab, carfilzomib, lenalidomide and dexamethasone [DKRd] or carfilzomib-based, bortezomib-based or daratumumab-based combinations) and salvage HDT/ASCT, previous studies reported CR or better in 23–67% of patients and VGPR or better in 71–78% of patients [ 15 , 16 , 31 , 32 ]. The apparently low rates of stringent CR and CR in the present study may reflect underreporting, as bone marrow punctures are not routinely performed after re-induction and after SCT outside of clinical trials, and data for this were not collected.…”

Section: Discussionmentioning

confidence: 99%

“…Regarding salvage stem cell transplantation (SCT), a key issue is the selection of an optimal re-induction therapy; nevertheless, guidance is limited, and the choice is often based on a patient’s response to, and toxicity of, prior therapies, their comorbidities and disease burden [ 14 ]. Furthermore, real-world evaluations of re-induction therapy prior to ASCT are scarce [ 15 , 16 ], and there are currently no published real-world studies that focus on the German treatment landscape. More information regarding treatment outcomes and treatment sequencing could support decision-making for physicians and improve patient care.…”

Section: Introductionmentioning

confidence: 99%

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Treatment pattern and outcomes of re-induction therapy prior to stem cell transplantation in patients with relapsed/refractory multiple myeloma in Germany

Sauer,

Engelhardt,

Trautmann-Grill

et al. 2024

Bone Marrow Transplant

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There are limited data guiding choice of re-induction therapies for patients with relapsed/refractory multiple myeloma (RRMM) prior to stem cell transplantation (SCT). We performed a retrospective medical chart review of 171 patients with RRMM in Germany who received re-induction therapy in second line (78%; n = 134) or third line (22%; n = 37) prior to re-SCT. Index therapy was defined as first completed re-induction therapy for planned myeloablative conditioning and SCT in second/third line within the eligibility period (1/2016–12/2019). Most common pre-index first line and maintenance therapy used were bortezomib-based combinations (91%; n = 155/171) and lenalidomide (55%; n = 29/53), respectively. Median duration of index therapy line was 9 months; carfilzomib-based combinations were the most widely used in second/third line re-induction therapy (49%; n = 83/171), followed by daratumumab-based combinations (21%; n = 36/171). Overall response rates in second/third line were 87% after re-induction and 96% after SCT; median time to next treatment line after start of index therapy was 31 months; median progression-free survival (PFS) was 29 months; and median overall survival after index date was not reached. Based on these data, re-induction therapy with salvage SCT appears to be beneficial in selected patients with RRMM in clinical practice in Germany, translating into deep responses, long PFS and prolonged time to next treatment.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Treatment pattern and outcomes of re-induction therapy prior to stem cell transplantation in patients with relapsed/refractory multiple myeloma in Germany

Sauer,

Engelhardt,

Trautmann-Grill

et al. 2024

Bone Marrow Transplant

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Outcomes after delayed and second autologous stem cell transplant in patients with relapsed multiple myeloma

Lemieux

Muffly

Iberri

et al. 2021

Bone Marrow Transplant

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Case report: pomalidomide as maintenance after salvage autologous stem cell transplantation in a patient with relapsed multiple myeloma

Semochkin,

Lunin,

Vernyuk

et al. 2023

Onkogematologiâ

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Currently, lenalidomide is the only immunomodulatory drug (IMiD) approved for maintenance therapy in patients with newly diagnosed multiple myeloma who have received high-dose chemotherapy and autologous stem cell transplantation (ASCT). The maintenance with lenalidomide showed an advantage over placebo or observation for both progression-free and overall survival in a series of phase 3 randomized trials. Salvage ASCT can be performed after disease relapse in case of a long-term response after the first transplantation or if this option has not been performed before. Pomalidomide is a third-generation IMiD approved for the treatment of relapsed and refractory multiple myeloma, which is efficient in patients with resistance to lenalidomide and proteasome inhibitors. Structurally, lenalidomide and pomalidomide are similar, and therefore the latter can also be considered as a drug for maintenance, however, there are no relevant phase 3 randomized trials. In this article, we present a clinical case of a 60-year-old patient with newly diagnosed multiple myeloma who progressed after 2 lines of induction therapy, which included lenalidomide and two proteasome inhibitors (bortezomib, ixazomib). The use of Pd combination (pomalidomide, dexamethasone) made it possible to achieve a repeated response and implement of salvage ASCT. The second ASCT was carried out only 12 months later after the first due to the COVID-19 pandemic. Subsequent long-term maintenance therapy with pomalidomide resulted in a complete response and minimal residual disease negativity. The resulting response has persisted at the time of this writing for over 2 years. To discuss the presented clinical case, the data of the French phase 2 IFM 2013-01 study were used, in which patients with failed first-line transplantation in case of relapse received PCd (pomalidomide, cyclophosphamide, dexamethasone) induction, salvage ASCT, and maintenance by Pd until disease progression. Pomalidomide may be an acceptable substitute for lenalidomide in patients with prior intolerance or refractory to this IMiD.

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Outcomes of Daratumumab, Pomalidomide, and Dexamethasone, Followed by High-dose Chemotherapy and Autologous Stem Cell Transplantation, in Patients With Relapsed/Refractory Multiple Myeloma

Cited by 3 publications

References 38 publications

Treatment pattern and outcomes of re-induction therapy prior to stem cell transplantation in patients with relapsed/refractory multiple myeloma in Germany

Treatment pattern and outcomes of re-induction therapy prior to stem cell transplantation in patients with relapsed/refractory multiple myeloma in Germany

Outcomes after delayed and second autologous stem cell transplant in patients with relapsed multiple myeloma

Case report: pomalidomide as maintenance after salvage autologous stem cell transplantation in a patient with relapsed multiple myeloma

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