KRD vs. VRD as induction before autologous hematopoietic progenitor cell transplantation for high-risk multiple myeloma

Mahmoud R. Gaballa, Junsheng Ma, Mikael Rauf, Roland Bassett, Oren Pasvolsky, Mark R. Tanner, Qaiser Bashir, Samer A. Srour, Neeraj Saini, Jeremy Ramdial, Yago Nieto, Regan Murphy, Katayoun Rezvani, Guilin Tang, Pei Lin, Hans C. Lee, Krina K. Patel, Muhammad R. Ullah, Gregory P. Kaufman, Elisabet E. ManasanchPartow Kebriaei, Sheeba K. Thomas, Donna M. Weber, Elizabeth J. Shpall, Richard E. Champlin, Robert Z. Orlowski, Muzaffar H. Qazilbash*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Bortezomib, lenalidomide, and dexamethasone (VRD) induction is standard prior to autologous hematopoietic cell transplantation (auto-HCT) in newly diagnosed, high-risk multiple myeloma (ND-HRMM). Carfilzomib (K) is another proteasome inhibitor approved for MM. In this single-center, retrospective analysis, we compared outcomes in ND-HRMM with pre-transplant KRD or VRD induction. High-risk was defined by t(4:14), t(14:16), 1q21 gain/amplification, or del(17p). Primary endpoints were progression-free (PFS) and overall survival (OS). Of 121 ND-HRMM patients, 63 received KRD, and 58 received VRD. Post-induction, complete (CR), very good partial (VGPR), partial response (PR), and overall response (ORR) rates were 23.8%/49.2%/25.4%/98.4% with KRD, and 19%/46.6%/27.6%/93.1% with VRD. At day 100 post-auto-HCT, these were 38.1%/42.9%/19%/100% with KRD, versus 35.1%/49.1%/12.3%/94.8% with VRD. Pre-auto-HCT, 11 (18.3%) KRD and 7 (12.5%) VRD patients had minimal residual disease (MRD)-negative CR (p = 0.45). Post-auto-HCT, 14 (41.2%) and 13 (43.3%) patients had MRD-negative CR (p = 1.000). Median PFS was 38.2 (95%CI 28.7-NA) and 45.9 months (95%CI 43.2-NA) for KRD and VRD, respectively (p = 0.25). Respective 3-year PFS and OS were 53.5% (95%CI 41.1–69.6) and 95.2% (95%CI 90–100) for KRD and 64% (95%CI 51.6–79.5) and 84.2% (95%CI 73.5–96.3, p = 0.30) for VRD. Overall, KRD induction pre-auto-HCT does not improve outcomes. Prospective, randomized studies are needed to confirm these findings.

Original languageEnglish
Pages (from-to)1142-1149
Number of pages8
JournalBone Marrow Transplantation
Volume57
Issue number7
DOIs
StatePublished - Jul 2022

Funding

FundersFunder number
Dr. Miriam and Sheldon G. Adelson Medical Research Foundation

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