Philippe Moreau, MD of University Hospital of Nantes, Nantes, France discusses frontline treatment for young multiple myeloma (MM) patients with Joan Bladé, MD of the Hospital Clinic, Barcelona, Spain and Gareth Morgan, MD, FRCP, FRCPath, PhD of UAMS of the Myeloma Institute, Little Rock, AR at the 2016 European Multiple Myeloma Academy (EMMA) in Madrid, Spain. First, they discuss the optimal induction regiment prior to stem cell transplantation. Prof. Moreau explains the current landscape and Prof. Morgan discusses the situation in the United States, emphasizing the importance of considering the aim of treatment. The next question compares early vs delayed stem cell transplantation. Prof. Morgan argues that stem cell transplant is better and, if it is dropped, the outcome is sub-optimal. In Europe, frontline stem cell transplantation is favored, as Prof. Moreau points out. Prof. Bladé then discusses the issue of age and stem cell transplantation; he believes that the age limit for clinical trials should be 65 but in clinical practice, patients up to age 70 or older, who are physically fit, can undergo autologous stem cell transplantation with a full dose of melphalan. The next question discussed is whether to perform one or tandem stem cell transplantation. Prof. Morgan, explains that for younger patients with low-risk disease, the evidence points to tandem autologous stem cell transplant. Prof. Bladé explains that there is a trend to go for two tandem transplants for patients with high-risk cytogenetics. Prof. Moreau then brings up the question of consolidation. Prof. Morgan explains the approach at his institution is two dose-reduced chemotherapies but now with immunologically active agents such as daratumumab, it may be better to change this approach and swap to consolidation daratumumab before going on to maintenance. Prof. Bladé then discusses the use of systematic consolidation with the group. Finally, to close the session, Prof. Morgan talks about the UK MRC Myeloma XI study (NCT01554852) on maintenance and that it will report at ASH; he is optimistic that it will be used to approve lenalidmoide maintenance in Europe. Further, he believes that single-agent lenalidomide is sub-optimal and that the question is how to improve on the baseline of bortezomib, lenalidomide, dexamethasone (VRd) maintenance.
This programme has been supported by Celgene and Amgen through an unrestricted educational grant to the Video Journal of Hematological Oncology.