Multiple myeloma: predicting response to lenalidomide-dexamethasone salvage therapy

  • Gassiot S, González Y, Morgades M, et al.
  • Clin Lymphoma Myeloma Leuk
  • 26 May 2019

  • curated by David Reilly
  • Univadis Clinical Summaries
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Takeaway

  • In patients with relapsed/refractory multiple myeloma (R/R MM), the major predictor of durable response to lenalidomide-dexamethasone (Ld) was achievement of partial response (PR) or better following the first treatment cycle.

Why this matters

  • Lenalidomide-based triplet combinations are superior to Ld in patients with R/R MM, but Ld is still considered a standard of care in select patients.

Study design

  • Multicenter study to identify characteristics predictive of durable response to Ld (n=227) in R/R MM.
  • 11% had prior known clonal plasma cell disorder in the form of smoldering multiple myeloma (SMM) or monoclonal gammopathy of undetermined significance (MGUS).
  • Funding: None disclosed.

Key results

  • 37% were identified as durable responders (defined as PFS of ≥24 months).
  • Baseline characteristics associated with PFS >24 months in multivariate analysis:
    • Standard cytogenetics: HR=2.86, P=.049.
    • MGUS/MM: HR=3.02, P=.049.
    • Treatment in first relapse: HR=2.07, P=.031.
  • Characteristics associated with PFS >24 months when including achievement of partial remission in cycle 1 in multivariate analysis:
    • Prior history of MGUS/SMM: HR=5.4, P=.006.
    • PR after cycle 1: HR=6.9, P<.001.>

Limitations

  • Retrospective data.

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