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IMS 2026 | Managing hematologic toxicity and infections with melflufen-based therapy in multiple myeloma
Fredrik Schjesvold, MD, PhD, Oslo University Hospital, Oslo, Norway, discusses hematologic adverse events and infections observed with melflufen, carfilzomib and dexamethasone in the SUCCESSOR-2 trial (NCT05552976). He highlights that neutropenia was generally manageable with proactive granulocyte colony-stimulating factor (G-CSF) support, while noting the importance of dose adjustment for other toxicities and Pneumocystis jirovecii pneumonia (PJP) prophylaxis when using melflufen-based therapy. This interview took place at the 23rd International Myeloma Society (IMS) Annual Meeting in Glasgow, UK.
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Transcript
SUCCESSOR-2 was published this spring. Melflufen plus carfilzomib-dex versus carfilzomib-dex. Significant PFS benefit, double PFS. Overall survival, the results still maturing. So we have learned a lot about melflufen in this study. Melflufen is a CELMoD, it’s a sort of super-imid, and the very common neutropenia effects of imids we also see in melflufen, maybe to even a little bit larger extent...
SUCCESSOR-2 was published this spring. Melflufen plus carfilzomib-dex versus carfilzomib-dex. Significant PFS benefit, double PFS. Overall survival, the results still maturing. So we have learned a lot about melflufen in this study. Melflufen is a CELMoD, it’s a sort of super-imid, and the very common neutropenia effects of imids we also see in melflufen, maybe to even a little bit larger extent. The main point is that neutropenia is not problematic. 99% of the patients with neutropenia can be easily managed with G-CSF. So this is not a problem. You just need to follow it and be proactive with using G-CSF instead of dose reducing, interrupting, those kind of things. That’s important. The symptom might also have some other side effects sometimes. Fatigue, like the image. For those things you need to dose reduce but not for the neutropenia. When it comes to infections we see that in the triplet versus a doublet we always see more infections whatever drug we add in myeloma but there is some infections in melflufen which is not so common in all other treatments. For instance, we saw a PJP, a pneumocystis, and that led to us using bactrim as a prophylaxis, like we do in bispecifics so I think it’s important that if you’re going to use this you need to use that same principle of prophylaxis of the PJP infections and we also saw some rare other diseases but they were very few patients so it’s not a big signal
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