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The 2022 Tandem Meetings | KRD vs VRD in high-risk multiple myeloma prior to autoHSCT

Mahmoud Gaballa, MD, Massachusetts General Hospital, Boston, MA, summarizes the results of a retrospective study comparing carfilzomib and lenalidomide plus dexamethasone (KRD) to bortezomib with lenalidomide plus dexamethasone (VRD) in patients with high-risk newly diagnosed multiple myeloma prior to autologous hematopoietic stem cell transplantation (autoHSCT). Overall, there were no significant differences between KRD or VRD, suggesting that the choice of induction regimen should be based on their toxicity profile. This interview took place at the Transplantation & Cellular Therapy (TCT) Meetings of ASTCT™ and CIBMTR® 2022 in Salt Lake City, Utah.

Transcript (edited for clarity)

Our study looked to answer the question if KRD is better than VRD as induction therapy for high-risk multiple myeloma patients before autologous stem cell transplantation. It included 121 newly diagnosed high-risk multiple myeloma patients, and those were subdivided as 63 KRD patients and 58 VRD patients. We defined high-risk as translocation 4;14, 14;16, 1q21 amplification, or del(17p).

We found that responses and MRD data were actually similar between both groups after induction and at day 100 after transplantation...

Our study looked to answer the question if KRD is better than VRD as induction therapy for high-risk multiple myeloma patients before autologous stem cell transplantation. It included 121 newly diagnosed high-risk multiple myeloma patients, and those were subdivided as 63 KRD patients and 58 VRD patients. We defined high-risk as translocation 4;14, 14;16, 1q21 amplification, or del(17p).

We found that responses and MRD data were actually similar between both groups after induction and at day 100 after transplantation. And similarly, the 3-year PFS and OS were also similar between both groups. The 3-year PFS in the KRD group was 53.5%, and in the VRD, it was 64%. And for the 3-year overall survival, the KRD group had 95.2% compared to 84.2% in the VRD group. So, overall, KRD induction prior to autologous stem cell transplantation in the high-risk patients did not show improvement. Of course, our study is a retrospective study, so it has to be confirmed in prospective randomized clinical trials. But, to me, this tells me that the choice between both regimens should be based on their toxicity profile, their side effect profile.

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