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EBMT 2020 | Treating newly-diagnosed myeloma

Maria-Victoria Mateos, MD, PhD, University Hospital of Salamanca, Salamanca, Spain, discusses how treatment is evolving in transplant-eligible, newly-diagnosed multiple myeloma patients. This interview was recorded via an online conference call with The Video Journal of Hematological Oncology (VJHemOnc).

Transcript (edited for clarity)

The treatment for transplant-eligible, newly-diagnosed myeloma patient is clearly evolving because although the standard of care continues to be an induction followed by high dose therapy, autologous stem cell transplant patient, and maintenance therapy. I think that important changes occurred within this convention and platform. First, because the main objectives have changed. And now we know that the depth of the response matters in the newly diagnosed myeloma patients, and a minimal residual disease assessment and minimal residual disease negativity is the new complete response...

The treatment for transplant-eligible, newly-diagnosed myeloma patient is clearly evolving because although the standard of care continues to be an induction followed by high dose therapy, autologous stem cell transplant patient, and maintenance therapy. I think that important changes occurred within this convention and platform. First, because the main objectives have changed. And now we know that the depth of the response matters in the newly diagnosed myeloma patients, and a minimal residual disease assessment and minimal residual disease negativity is the new complete response. And this would be the main objective for every newly-diagnosed myeloma patient, transplant eligible. The second important change is the induction regimes because we are moving from two to three drug-based combination and from three drug-based combination to three drug-based combination plus the monoclonal antibodies today targeting CD38, but in the future, we will have monoclonal antibodies targeting different antigens expressed on this survey. It’s of the plasma cells.

But another important question around the transplant eligibility is if every newly-diagnosed myeloma patient, transplant-eligible, has to receive autologous STEM cell transplantation or in other words, if we can potentially skip transplanting some patients. Today we don’t have a consolidated data in order to answer to this question, but I think that the data are different factors that can be considered in order to make the right choice. The risk status… And we have to consider not only the ISS staging, but also the cytogenetic abnormalities together with the minimal residual disease assessment. And the data we are coming from phase two, randomized studies, in which it’s true that the question has not been specifically, what is the role of transplant, indicates that it, may be in the future, patients at ISS-1 with no high risk cytogenetic abnormalities. If after optimal induction regimes, they achieve minimal residual disease negative.

And this minimal residual disease negative is sustained overtime could potentially skip autologous stem cell transplantation because the outcome could be comparable to those patients receiving autologous stem cell transplantation. And the main advantage for patient is that they will be free of exposition to hide those melphalan, followed by autologous stem cell transplantation, admission into the hospital for approximately one month. And the same side effect is that it can require after autologous stem cell transplantation. However, I would like to remark that we don’t have yet a consolidated data to support this. This is something that it is being investigated in clinical trials. And definitely we need the data coming from phase three randomized trials in order to consolidate the role of autologous stem cell transplantation. And today, in 2020, I have summarized that high dose therapy, followed by autologous stem cell transplantation, continues being the standard of care for newly-diagnosed myeloma patients. If we consider that the patient is transplant-eligible based not only on the chronological age, but the biological age comorbidities, disabilities, and to patient’s preferences.

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