EHA 2025 | The REST trial: isatuximab, bortezomib, lenalidomide, and dexamethasone in transplant-ineligible MM

The REST trial is a trial for the transplant ineligible. It was based in the Nordics in Europe, 50 patients with a quadruplet of Isa-VR and a little bit of Dex. The plan for this was, it was a sort of two-part plan. We wanted to show that the addition, what we do is we give ISA and Velcade and Revlamid as standard now, but to remove the extra after two cycles because these are transplant-ineligible and many are old. So the median age was actually 77 and 25% were over 80. So it’s a very elderly population, more elderly than MAIA and much more elderly than CEPHEUS and IMROZ. What we wanted to show was two things. We wanted to show that having bortezomib there weekly for the first eight cycles instead of the Dex would improve on the MAIA treatment with RRD. And it did. It was a 37% MRD negative rate while it’s 25% in MAIA. So quite clear benefit. But it’s also a modified way of giving this quadruplet now with the IMROZ and the CEPHEUS to the elderly. Because in that study, the average age was about 70, 72, and there was a cutoff at 80. We have much more elderly patients, so we’re showing that you can give a quadruplet safely and very high efficacy to the more elderly and frail patients with this quadruplet, modified the way we do it in the REST trial.

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