Parameswaran Hari, MD, MRCP, Discusses Second Malignancies and Second Transplants in Multiple Myeloma Treatment

Parameswaran Hari, MD, MRCP, discussed second malignancies and second transplants for patients who stopped versus continued lenalidomide maintenance therapy to treat multiple myeloma from a follow-up trial presented at the 2020 ASCO Virtual Scientific Program.

Transcription:

One of the big things that plays high in patients’ minds is the chance of second malignancies, second primary malignancies, so we looked at the incidence of that. The risk of second primary malignancies goes throughout the course of (lenalidomide) maintenance and the overall risk at 6 years we found was about 7-10% for second primary malignancies. Of that, what we really worry about the most is hematological malignancies or blood cancers and that’s only half of these patients. So that’s actually a good sign, about 45% of patients who got another blood cancer like a lymphoma or a leukemia or something more severe than myeloma. However, again one of the reasons that’s given for stopping (lenalidomide) maintenance at 3 years is that your risk of cancer goes down if you stop at 3 years. We actually did not see that. We saw that whether you stop (lenalidomide) maintenance or not, your risk of second malignancies over the entire 6-year period remains the same. That’s actually another interesting finding that we had.

If you got a second transplant, your progression-free survival was superior at 6 years compared to the other 2 arms. So, we actually have a nice hypothesis that doing a second transplant might still be beneficial we just weren’t able to pick it up in this study. The reason for doing this and presenting it is because all the European studies still show that a second transplant is beneficial compared to just doing 1 transplant. That’s why we did this analysis, and we find that to be interesting. So, this is something that physicians will have to consider.