Abstract
More than 900 abstracts on multiple myeloma were presented at this year’s ASH in San Diego. Several trials explored the addition of the monoclonal antibody daratumumab to established treatment regimens in both newly diagnosed as well as relapsed and refractory multiple myeloma. A long-awaited study tried to evaluate the role of double autologous stem cell transplant in multiple myeloma in newly diagnosed transplant eligible multiple myeloma. In relapsed and refractory multiple myeloma updates from several large trials like CASTOR and POLLUX were presented. Another spotlight were lenalidomide-refractory patients, an important patient group that is emerging as an increasingly challenging collective. Finally, abstracts on several novel agents like selinexor, venetoclax, isatuximab, melflufen and AMG420 were presented. Although still very preliminary, these data are already quite promising and illustrate the ever-changing treatment landscape in multiple myeloma.
Highlights
One of the most eagerly awaited presentations was the data from the FORTE trial evaluating the role of carfilzomib in newly diagnosed multiple myeloma (NDMM) patients eligible for autologous stem cell transplantation (ASCT)
After a median follow-up of 20 months, KRd-ASCT-KRd was superior to KCd-ASCT-KCd regarding pre-maintenance stringent complete repsonse, ≥ very good partial response (VGPR, 86% vs. 74%), and minimal residual disease (MRD) negativity 10–5 (58% vs. 41%)
After a median follow-up of 10 years, double ASCT proved superior in terms of PFS and overall survival (OS), with both benefits remaining significant in patients with high-risk cytogenetics
Summary
This review can only present a small selection of the data presented at last year’s ASH, it highlights certain trends for the future. We will see an extension of established triplet to quadruplet regimens as more data on combinations with monoclonal antibodies become available. Monoclonal antibodies and second-generation PIs are on their way to entering treatment strategies in early disease phases, with acceptable toxicity profile and excellent tolerability. More emphasis should lie on distinct patient groups such as patients with high-risk cytogenetics and the role of early tandem transplantation in these patients. Another cohort of patients that is likely to become more important in the years is the group of patients refractory to IMIDs and/or PIs. To date, only limited data on alternative treatment options are available but these will be the focus of large future trials. Isatuximab, AMG420, and melflufen are part of a second wave of novel agents that will further diversify treatment options in multiple myeloma in the coming years
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