Role of Transplant in Multiple Myeloma

EP: 1.Patient Profile 1: A 45-Year-Old with Transplant-Eligible Multiple Myeloma

EP: 2.Key Updates from the GRIFFIN Trial in Multiple Myeloma

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EP: 3.Role of Transplant in Multiple Myeloma

EP: 4.Features of High-Risk Multiple Myeloma and Clinical Trial Landscape

EP: 5.Measuring Treatment Response Following Induction Therapy in Patients with MM

EP: 6.Maintenance Therapy Considerations for Standard- and High-Risk MM

EP: 7.Experts Spotlight Some of The ‘Biggest Concerns’ In Multiple Myeloma

EP: 8.Patient Profile 2: A 79-Year-Old with Multiple Myeloma

EP: 9.MAIA Trial: DRd vs Rd in Transplant-Ineligible Patients with MM

EP: 10.Treatment Considerations for Transplant-Ineligible Patients with MM

EP: 11.CAR T-Cell Therapy in Transplant-Ineligible Patients with MM

EP: 12.Patient Profile 3: A 73-Year-Old with MM Treated with CAR T and Teclistamab

EP: 13.CAR T-Cell Therapy in the Treatment of Multiple Myeloma

EP: 14.MM: CAR T-Cell Therapy vs Bispecific T-Cell Engagers

EP: 15.BCMA Bispecific T-Cell Engagers in the Treatment of MM

EP: 16.Treatment Considerations for Bispecific Antibodies and Unmet Needs in MM

Transcript:

Al-Ola Abdallah, MD: Nausheen, there have been a lot of trials for stem cell transplant. I’ll be honest: transplant has been the standard of care. Nobody in this room would disagree with that. [Based on] the last trials we saw, like when they compared the GRIFFIN trial, we’re going to do RVd [lenalidomide, bortezomib, dexamethasone]–transplant vs daratumumab–RVd [lenalidomide, bortezomib, dexamethasone]–transplant. But transplant is the main thing. There are other trials and a lot of questions. If there’s no overall survival benefit from the transplant, can we drop the transplant and use it, especially in standard-risk [disease]? We have the DETERMINATION, IFM 2009, and FORTE trials. Can you give us your input? You do a lot of transplants for myeloma. What’s the rule of transplant now, especially with these studies?

Nausheen Ahmed, MD: Thank you, Abdullah. We do transplants at many institutions. Nationally, we still have up-front transplant as a standard of care, and it’s based on the IFM 2009 trial, which randomized patients to get RVd [lenalidomide, bortezomib, dexamethasone] followed by maintenance or RVd [lenalidomide, bortezomib, dexamethasone] with transplant and then maintenance. There was a progression-free survival [PFS] advantage for those who got a transplant. It was a 1- to 2-year difference, which is pretty significant in the long run for patients with myeloma.

More recently, the results of the DETERMINATION trial were published in NEJM [New England Journal of Medicine], which had 2 arms: an arm with RVd [lenalidomide, bortezomib, dexamethasone] induction followed by transplant and then maintenance vs induction followed by maintenance, which would continue to progression. There was a good number of patients, 300-plus in each arm. In that study, the patients who didn’t get the transplant had a PFS of around 3 years. In the other arm, in the ones who had transplant, it was 5 to 6 years. You’re seeing a 2-year difference in PFS.

I agree that we haven’t seen an overall survival difference, but that’s probably because patients in both the groups are going to do well for a long time. We haven’t had the chance to capture that difference. We’ll see how things roll out. But given the data we have, this is still standard of care.

Al-Ola Abdallah, MD: I agree. We also have to agree that a high-risk myeloma transplant is where we need to push for [this]. This is a fit patient in his 40s. Talking about PFS, I prefer to get longer PFS for this patient.

Jordan, we’ve talked about the GRIFFIN trial. We have 4 drugs, including daratumumab. We feel comfortable with RVd [lenalidomide, bortezomib, dexamethasone] and transplant. Nausheen talked about how transplant is still the standard of care. We still have to do it. There was always a concern that about if you had a fourth drug, like daratumumab, will that impact the stem cell collection for the patient? That’s a common question that we’ve been getting. Any comments about that?

Jordan Snyder, PharmD: The addition of daratumumab to RVd [lenalidomide, bortezomib, dexamethasone] in the GRIFFIN trial resulted in numerically fewer stem cells collected, but it didn’t seem to have an effect on the ability to cryopreserve for additional transplants should a patient need it. It’s important to note that they did require more plerixafor up front vs patients who received only RVd [lenalidomide, bortezomib, dexamethasone], which can increase costs and adverse effects for these patients. As far as adverse effects go, adding daratumumab to RVd [lenalidomide, bortezomib, dexamethasone] resulted in higher rates of cytopenias, particularly neutropenia and thrombocytopenia. [There were] higher rates of infection, but when we look at grade 3/4 infections between the treatment arms, they were pretty similar. For patients who received daratumumab, the majority of infections were mild and able to be managed pretty easily.

Al-Ola Abdallah, MD: I agree. One important thing is to look at the benefit of adding a drug and whether it can overcome any adverse effects from the treatment.

Transcript edited for clarity.