ASH 2023 | Optimizing maintenance therapy in multiple myeloma: an analysis from the PREAMBLE registry
Karthik Ramasamy, MBBS, MRCP, FRCPath, PhD, Oxford University Hospitals NHS Foundation Trust, Oxford, UK, discusses an analysis from the PREAMBLE registry focusing on optimal maintenance therapy following autologous stem cell transplantation (autoSCT) in multiple myeloma (MM). The study highlights lenalidomide monotherapy as an effective standard of care (SoC). However, for patients discontinuing treatment or those with higher-risk MM, combination therapy is feasible. The PERSEUS trial (NCT03710603) demonstrates the efficacy of combining lenalidomide with daratumumab. This interview took place at the 65th ASH Annual Meeting and Exposition, held in San Diego, CA.
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Transcript (edited for clarity)
PREAMBLE was one of the first real-world registries ever set up in the field of multiple myeloma. This started well over ten years ago, before a lot of other recent registries have kicked off. I’ve been fortunate to be part of this PREAMBLE registry as steering committee. And what we’ve started to do is to analyze several subsets of data within this registry.
The focus of what we presented at ASH 2023 was to look at maintenance therapies...
PREAMBLE was one of the first real-world registries ever set up in the field of multiple myeloma. This started well over ten years ago, before a lot of other recent registries have kicked off. I’ve been fortunate to be part of this PREAMBLE registry as steering committee. And what we’ve started to do is to analyze several subsets of data within this registry.
The focus of what we presented at ASH 2023 was to look at maintenance therapies. What we did was look at what types of maintenance were offered to patients and how long these maintenance therapies were given, what were the discontinuation rates looking like, and whether addition of drugs to lenalidomide, which is by far the leading maintenance agent, is adding clinical benefit to patients. What we found in the PREAMBLE registry is close to about 30-40% of patients are getting combination maintenance therapy. Those patients receiving lenalidomide maintenance, which is the current standard-of-care across the world, we did find up to 20-25% of patients discontinuing treatment early, and quite a proportion of these patients were due to toxicity. It is very clear that patients who are able to continue on lenalidomide maintenance monotherapy do enjoy a good progression-free survival up to three years. It did appear that patients who received combination maintenance therapy had poorer outcomes, meaning poorer PFS, but it is clear that combination maintenance therapy is offered to patients who have higher-risk disease identified by clinicians at baseline. If you take what we’ve seen at ASH 2023, in the form of daratumumab and lenalidomide maintenance in the PERSEUS trial, what you can already see is incorporating a combination maintenance therapy would not be difficult because it is already practiced in up to 30-40% of patients in routine clinical practice.
So the main messages are lenalidomide maintenance still remains dominant, but we have challenges in our ability to continue land maintenance. I think if combination maintenance therapy is of significant benefit, such as daratumumab and lenalidomide for a proportion of patients, and therefore subanalysis of PERSEUS is important, then incorporating that into routine clinical practice should not be challenging.
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Disclosures
Sanofi: Honoraria, Membership on an entity’s Board of Directors or advisory committees; Adaptive Biotech: Honoraria, Membership on an entity’s Board of Directors or advisory committees; GSK: Honoraria, Membership on an entity’s Board of Directors or advisory committees, Research Funding; Menarini Stemline: Honoraria, Membership on an entity’s Board of Directors or advisory committees; Recordati: Honoraria; BMS ( Celgene): Honoraria, Membership on an entity’s Board of Directors or advisory committees, Research Funding; Takeda: Honoraria, Membership on an entity’s Board of Directors or advisory committees; Pfizer: Honoraria, Membership on an entity’s Board of Directors or advisory committees; Amgen: Honoraria, Membership on an entity’s Board of Directors or advisory committees, Research Funding; Janssen: Honoraria, Membership on an entity’s Board of Directors or advisory committees, Research Funding.
