IMS 2022 Express is the first to demonstrate that prolonged KRd therapy is superior to lenalidomide monotherapy for maintenance of PFS after MM autotransplantation

Treatment options for patients with multiple myeloma (MM) after autologous hematopoietic stem cell transplantation (ASCT) have been an area of ​​active exploration by researchers

This international open-label phase 3 randomized trial enrolled newly diagnosed MM patients who received ≤12 months of induction therapy followed by a single ASCT and achieved at least stable disease after 100 days

Patients randomized to the KRd arm received KRd treatment in a 28-day cycle

The primary endpoint of the study was progression-free survival (PFS)

figure 1

Research result

As of October 21, 2020, 180 patients (n=87 in R arm; n=93 in KRd arm) were enrolled, and 2 patients withdrew from the study before starting treatment; data cutoff date is December 31, 2021

figure 2

At a median follow-up of 33.

image 3

After 6 cycles, 44% and 27% of patients in the KRd group (n=90) and R group (n=84), respectively, achieved MRD negativity (p=0.

Figure 4

At data cutoff, 20 patients had died [KRd vs R: 9 (9.
8%) vs 11 (12.
8%)]
.

The median OS was NR (95% CI NR-NR) and 81.
8 months (95% CI 61.
8-NR) in the KRD and R groups, respectively (HR 0.
92, p=0.
86)
.

Ninety percent of patients in the KRd group and 87% in the R group survived
.

All grades of toxicity were roughly equivalent between the two groups
.

The most common grade 3+ adverse events (AEs) and AEs of particular concern were neutropenia (KRd vs R: 47% vs 63%), thrombocytopenia (13% vs 7%), infection ( 17% vs 8%), cardiovascular toxicity (4% vs 6%), and secondary malignancies (0 vs 1 patient)
.

Analysis conclusion

This is the first randomized phase III trial to demonstrate that prolonged KRd therapy after transplantation is superior to R maintenance therapy in PFS
.

Therefore, prolonged KRd therapy after MRD/risk-adapted ASCT may become a new alternative and standard of care
.

Reference source:

Andrzej Jakubowiak, et al.
Atlas: a phase 3 randomized trial of carfilzomib, lenalidomide, and dexamethasone versus lenalidomide alone after stem-cell transplant for multiple myeloma.
2022IMS.
Abstract#OAB-010.

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