|The following article features coverage from the 2021 American Society of Clinical Oncology (ASCO) Annual Meeting. Click here to read more of Hematology Advisor‘s conference coverage.|
Among patients with newly diagnosed, transplant-eligible multiple myeloma (MM), a carfilzomib-based consolidation and maintenance therapy regimen may yield inferior outcomes to those seen with autologous stem cell transplantation (ASCT), according to research presented at the 2021 American Society of Clinical Oncology (ASCO) Annual Meeting.
Many patients with newly diagnosed MM will undergo ASCT after induction and consolidation therapy. While clinical trial data support the use of ASCT in this setting, many maintenance regimens rely on lenalidomide, which may benefit patients with standard risk–disease only. For this phase 3 trial (CARDAMON; ClinicalTrials.gov Identifier: NCT02315716), researchers evaluated the safety and efficacy of a carfilzomib-based induction and maintenance regimen among patients vs that of ASCT.
Overall, 281 patients were enrolled. Patients received a carfilzomib, cyclophosphamide, and dexamethasone induction regimen and were then randomly assigned 1:1 to receive ASCT or a carfilzomib, cyclophosphamide, and dexamethasone consolidation regimen. The median patient age was 59 years (range, 33-74) and 24% of patients were considered high risk.
After induction therapy, the rate of very good partial responses (VGPR) or better was 58.5%, and the overall response rate was 87%; patients considered high- vs standard-risk had similar response rates.
After induction, 109 patients were randomly assigned to undergo ASCT and 109 were assigned to the consolidation combination. The VGPR or better rate was 78.5% in the consolidation group vs 80% in the ASCT group (P =.8).
The median follow-up was 37.5 months, at which point the median progression-free survival (PFS) was 3.4 years in the consolidation group vs not reached in the ASCT group. The observed 2-year PFS rate was 70% in the consolidation group vs 76% in the ASCT group, corresponding to a -5.8% difference in PFS (95% CI: -10.4-0.3).
Patients who were considered high risk had worse outcomes overall, though these outcomes were not considered related to treatment group assignment.
Minimal residual disease rates after induction were 24.3%, though these rates were lower in the consolidation group after treatment (35.8%) than in the ASCT group (53.1%; P =.02).
Grade 3 or worse adverse events after induction included infection (18.7%), hypertension (11.2%), anemia (10.4%), cardiac disorder (3.6%), vomiting (2.2%), fatigue (2.2%), and diarrhea (1.8%).
Disclosure: The study author(s) declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.
Read more of Hematology Advisor’s coverage of the 2021 ASCO Annual Meeting by visiting the conference page.
Yong K, Camilleri M, Wilson W, et al. Upfront autologous stem cell transplantation (ASCT) versus carfilzomib-cyclophosphamide-dexamethasone (KCd) consolidation with K maintenance in transplant-eligible, newly diagnosed (NDTE) multiple myeloma (MM). J Clin Oncol. 2021;39:(suppl 15; abstr 8000). doi:10.1200/JCO.2021.39.15_suppl.8000