ASH 2020 | Genomic changes induced by high-dose melphalan in myeloma
Nikhil Munshi, MD, Dana-Farber Cancer Institute, Boston, MA, shares the results of a retrospective genomic analysis of multiple myeloma patients randomized to receive lenalidomide-bortezomib-dexamethasone (RVD) or high-dose melphalan (HDM)+RVD in the Phase III IFM/DFCI2009 trial (NCT01191060). HDM demonstrates significant survival benefits when used prior to autologous stem cell transplantation, but the impact of its alkylating activity in surviving myeloma cells was unclear. Paired patient samples from diagnosis and relapse were sequenced, revealing a significantly higher mutation accumulation rate in the HDM+RVD arm compared to RVD alone. No differences in the number of copy number alterations or structural variants were seen. The results identify a need for re-evaluation of optimal HDM use in multiple myeloma. This interview took place during the 62nd American Society of Hematology (ASH) Annual Meeting and Exposition, 2020.
