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ASH 2024 | Sustained MRD negativity for three years can guide discontinuation of LEN maintenance in myeloma
Evangelos Terpos, MD, PhD, University of Athens School of Medicine, Athens, Greece, comments on the results of a prospective cohort study investigating the discontinuation of lenalidomide (LEN) maintenance after autologous stem cell transplantation (autoSCT) in patients with multiple myeloma (MM) who achieved sustained measurable residual disease (MRD) negativity for three years. Dr Terpos highlights that only 7% of patients in the study progressed to myeloma and notes that the risk of progression was not associated with specific patient characteristics. This interview took place at the 66th ASH Annual Meeting and Exposition, held in San Diego, CA.
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Transcript (AI-generated)
This is another oral presentation of my group where I think it’s probably the most important presentation of my group in this conference. So what we did is that patients who received an induction treatment, autologous transplant, plus or minus consolidation and maintenance with lenalidomide, at the time that they had achieved sustained MRD negativity for three years, both in the bone marrow and in PET-CT, so we had also imaging MRD negativity, we stopped lenalidomide and we followed the patients...
This is another oral presentation of my group where I think it’s probably the most important presentation of my group in this conference. So what we did is that patients who received an induction treatment, autologous transplant, plus or minus consolidation and maintenance with lenalidomide, at the time that they had achieved sustained MRD negativity for three years, both in the bone marrow and in PET-CT, so we had also imaging MRD negativity, we stopped lenalidomide and we followed the patients.
So, 52 patients fulfilled the criteria of three years sustained MRD negativity, both in the bone marrow and imaging MRD negativity. And these patients stopped lenalidomide and had a median follow-up of around three years. What we’ve seen is that approximately 25% of these patients became from MRD negative to MRD positive. None of them had immediate progression to myeloma, biochemical progression or clinical progression, before going from MRD negativity to MRD positivity.
Second design, important design of this study, is that for those patients who became from MRD negative to MRD positive, lenalidomide was re-administered at the dose of lenalidomide maintenance that the patient received at the time of discontinuation. So, from those patients, I think there were 12 patients who became from MRD negative to MRD positive, from these patients only four progressed even with the re-administration of lenalidomide and progressed to myeloma, three of them had biochemical relapse and one of them had clinical relapse.
So in general we can say that if a patient has three years of sustained MRD negativity, the probability of progression after the stopping of lenalidomide maintenance was only 7% and we didn’t see that this 7% had specific characteristics, for example, if all of these were high-risk patients. These 4 patients were 2 of them had high-risk, 2 of them had standard-risk disease.
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Disclosures
Amgen: Honoraria, Other: Travel expenses, Research Funding; AstraZeneca: Honoraria, Other: Travel expenses; BMS: Honoraria; EUSA Pharma: Honoraria, Other: Travel expenses; Janssen: Honoraria, Research Funding; GSK: Honoraria, Research Funding; Menarini/Stemline: Honoraria; Pfizer: Honoraria; Sanofi: Honoraria, Other: Travel expenses, Research Funding; Takeda: Honoraria, Other: Travel expenses, Research Funding; Novartis: Honoraria; Antengene: Honoraria, Research Funding; Swixx: Honoraria.
