TY - JOUR
T1 - KRD vs. VRD as induction before autologous hematopoietic progenitor cell transplantation for high-risk multiple myeloma
AU - Gaballa, Mahmoud R.
AU - Ma, Junsheng
AU - Rauf, Mikael
AU - Bassett, Roland
AU - Pasvolsky, Oren
AU - Tanner, Mark R.
AU - Bashir, Qaiser
AU - Srour, Samer A.
AU - Saini, Neeraj
AU - Ramdial, Jeremy
AU - Nieto, Yago
AU - Murphy, Regan
AU - Rezvani, Katayoun
AU - Tang, Guilin
AU - Lin, Pei
AU - Lee, Hans C.
AU - Patel, Krina K.
AU - Ullah, Muhammad R.
AU - Kaufman, Gregory P.
AU - Manasanch, Elisabet E.
AU - Kebriaei, Partow
AU - Thomas, Sheeba K.
AU - Weber, Donna M.
AU - Shpall, Elizabeth J.
AU - Champlin, Richard E.
AU - Orlowski, Robert Z.
AU - Qazilbash, Muzaffar H.
N1 - Publisher Copyright:
© 2022, The Author(s), under exclusive licence to Springer Nature Limited.
PY - 2022/7
Y1 - 2022/7
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=85129506523&partnerID=8YFLogxK
U2 - 10.1038/s41409-022-01697-4
DO - 10.1038/s41409-022-01697-4
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C2 - 35523847
AN - SCOPUS:85129506523
SN - 0268-3369
VL - 57
SP - 1142
EP - 1149
JO - Bone Marrow Transplantation
JF - Bone Marrow Transplantation
IS - 7
ER -
