Andrew Branagan, MD, a medical oncologist at Massachusetts General Hospital Cancer Center,discusses novel induction therapies being used with transplant to improve outcomes in patients with multiple myeloma.

The field of multiple myeloma has come a long way with regard to induction therapies, Branagan explains. While very good partial remission (VGPR) rates were previously less than 50%, they are now observed in two-thirds of patients. Some data have indicated that up to 100% of patients achieve VGPR with certain regimens, making it difficult to decide which approach to use. 

Currently, the standard regimen is the combination of lenalidomide (Revlimid), bortezomib (Velcade), and daratumumab (Darzalex). Some growing data suggest that current standards will probably change in the near future, concludes Branagan.

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Andrew Branagan, MD, discusses novel induction therapies being used with transplant to improve outcomes in patients with multiple myeloma.


Dr. Branagan on Novel Induction Therapies With Transplant in Myeloma

Andrew Branagan, MD, a medical oncologist in the Center for Multiple Myeloma at Mass General Cancer Center in Massachusetts General Hospital, discusses the role of autologous stem cell transplantation (ASCT) in patients with high-risk multiple myeloma.

The role of transplant has been a mainstay in multiple myeloma as it can lead to improved progression-free survival and overall survival for patients with high-risk disease, says Branagan.

As such, up-front transplant is recommended for transplant-eligible patients, says Branagan.

Age is a factor in determining transplant eligibility, explains Branagan. Historically, patients had to be under the age of 65 to be eligible for transplant. However, in the United States, patients are able to be transplanted into their early 70s.

Additionally, patients who are eligible for ASCT should not have major comorbidities and should not be frail, concludes Branagan.

Andrew Branagan, MD, discusses the role of autologous stem cell transplantation in patients with high-risk multiple myeloma.



Dr. Branagan on the Role of Transplant in High-Risk Multiple Myeloma

Andrew Branagan, MD, a medical oncologist in the Center for Multiple Myeloma at Mass General Cancer Center in Massachusetts General Hospital, discusses the results of the phase 3 TOURMALINE-MM3 trial in multiple myeloma.

Lenalidomide (Revlimid) maintenance is not sufficient for patients with high-risk cytogenetics or other high-risk features, explains Branagan. However, data from the TOURMALINE-MM3 trial showed that patients with high-risk cytogenetics did just as well on ixazomib (Ninlaro) as standard-risk patients do on lenalidomide. As such, proteasome inhibitors have become the preferred maintenance option for patients with high-risk cytogenetics, says Branagan.

The next step will be to evaluate the combination of ixazomib plus lenalidomide versus lenalidomide alone. Moreover, now that proteasome inhibitors have shown benefit in this setting, researchers could consider evaluating monoclonal antibodies, such as daratumumab (Darzalex) or isatuximab-irfc (Sarclisa).

In the interim, Branagan recommends combining lenalidomide with a proteasome inhibitor for high-risk patients. Most commonly, bortezomib (Velcade) is given every other week. However, if a patient can’t tolerate bortezomib, ixazomib is an appropriate option, concludes Branagan.

Andrew Branagan, MD, discusses the results of the phase 3 TOURMALINE-MM3 trial in multiple myeloma.

Dr. Branagan on the Results of the TOURMALINE-MM3 Trial in Multiple Myeloma

Andrew Branagan, MD, a medical oncologist in the Center for Multiple Myeloma at Mass General Cancer Center in Massachusetts General Hospital, discusses the research tandem transplants in patients with high-risk multiple myeloma.

Tandem transplants, meaning 2 back-to-back transplants, are being investigated in multiple myeloma treatment, explains Branagan. Tandem transplants are not a new concept and have occurred in the past, according to Branagan.

The European Society for Blood and Marrow Transplantation conducted a promising study showing that doing tandem transplant was beneficial in high-risk patients with multiple myeloma; however, these results were not validated in the United States, says Branagan. Tandem transplants, according to Branagan, are not going to change practice yet, but it is a consideration for a high-risk patient to do 2 transplants back-to-back.

Andrew Branagan, MD, discusses the research tandem transplants in patients with high-risk multiple myeloma.

Andrew Branagan, MD

Articles

Dr. Branagan on Novel Induction Therapies With Transplant in Myeloma

Dr. Branagan on the Role of Transplant in High-Risk Multiple Myeloma

Dr. Branagan on the Results of the TOURMALINE-MM3 Trial in Multiple Myeloma

Dr. Branagan on Tandem Transplants in Multiple Myeloma