2020 Year in Review - Multiple Myeloma

The year 2020 was an unprecedented year, bringing significant changes in the practice of medicine and knowledge sharing at scientific forums. National and international meetings, such as the European Hematological Association (EHA) and the American Society of Hematology (ASH), pivoted to facilitate the dissemination of information regarding cutting-edge research and treatment advances in a virtual format.
According to data from the phase 2 FORTE trial, 3 different techniques were analyzed and compared to characterize minimal residual disease (MRD), including positron emission tomography/computed tomography (PET/CT), multiparameter flow cytometry (MFC), and next-generation sequencing (NGS).
Recent studies have illustrated complete response (CR) rates >50% for transplant-eligible patients with multiple myeloma (MM) treated with optimized induction followed by high-dose therapy (HDT) and autologous stem-cell transplantation (ASCT). However, many patients relapse early. Patients who relapse are generally thought to have very low survival rates.
Poor response on subsequent therapies is typically seen in patients with relapsed/refractory multiple myeloma (RRMM) who have had 3 prior lines of therapy with immunomodulatory drugs (IMiDs), proteasome inhibitors (PIs), and anti-CD38 monoclonal antibodies. In addition, challenges for future treatment options are presented.
This multicenter, retrospective, real-world study (GEM-POMCIDEX) was initiated to evaluate the effectiveness of the guidelines established by the Spanish Myeloma Group (PETHEMA) to treat appropriate patients with relapsed/refractory multiple myeloma (RRMM) with pomalidomide, cyclophosphamide, and dexamethasone (POMCIDEX).
Comparing consolidation treatment with bortezomib + lenalidomide + dexamethasone (VRD) followed by lenalidomide maintenance with lenalidomide maintenance alone, the former approach was superior regarding progression-free survival (PFS) and myeloma response in patients with newly diagnosed multiple myeloma (MM) with an acceptable toxicity profile.
The randomized FORTE trial showed that patients who were newly diagnosed with transplant-eligible multiple myeloma (MM) experienced significantly improved progression-free survival (PFS) with carfilzomib plus lenalidomide-dexamethasone (KRd) induction-ASCT-KRd consolidation versus either 12 KRd cycles or carfilzomib plus cyclophosphamide-dexamethasone (KCd) induction-ASCT-KCd consolidation.
TOURMALINE-MM4 is an international, multicenter, double-blind, placebo-controlled, phase 3 study that examined the efficacy and safety profile of oral ixazomib as maintenance therapy in patients with newly diagnosed multiple myeloma (NDMM) who have not undergone stem-cell transplantation after initial treatment and its impact on progression-free survival (PFS) compared with those taking placebo.
Based on a phase 2 trial, interim results exploring the response to ixazomib, lenalidomide, and dexamethasone (IRd) induction followed by a single autologous stem-cell transplantation (ASCT), IRd consolidation, and risk-based maintenance found a 93% overall response rate (ORR).
Patients with relapsed/refractory multiple myeloma (RRMM) who have had ≥2 prior lines of therapy, including an immunomodulatory drug (IMiD) and a proteasome inhibitor (PI), and who were refractory to pomalidomide and/or an anti-CD38 monoclonal antibody were evaluated in a phase 2 single-arm, multicenter study known as HORIZON.
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