Sarah M. Larson, MD, assistant professor of medicine, and director, Multiple Myeloma Program, University of California, Los Angeles, discusses the impact of minimal residual disease (MRD) on treatment decisions in multiple myeloma.

With the many treatment advances made in multiple myeloma, patients are now achieving MRD negativity, says Larson. However, the specific way to achieve MRD negativity and the implications on practice remain largely unknown in the frontline setting following stem cell transplant. Following transplant, there’s also the discussion of maintenance and whether lenalidomide (Revlimid), ixazomib (Ninlaro), or a combination should be administered, adds Larson. Whether MRD testing should be done with maintenance therapy, similar to stem cell transplant, is also an open question.

In terms of frontline clinical trials, the field is anticipating data from the phase II GRIFFIN trial and the phase III COBRA trial. In the GRIFFIN trial, investigators are evaluating bortezomib, lenalidomide, and dexamethasone (VRd) versus VRd plus daratumumab (Darzalex). Initial results seemed to favor the daratumumab arm, but more mature data are needed. In the COBRA trial, investigators are evaluating carfilzomib (Kyprolis), lenalidomide, and dexamethasone (KRd) versus VRd, which, if positive, could be practice changing, concludes Larson.

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Dr. Larson on the Impact of MRD on Treatment Decisions in Multiple Myeloma

Sarah M. Larson, MD, assistant professor, University of California, Los Angeles, discusses potentially practice-changing studies for patients with transplant-eligible and -ineligible multiple myeloma.

Frontline therapy for transplant-eligible multiple myeloma has progressed in recent years where patients can get to a minimal residual disease (MRD) state; however, questions about how to best treat patients still remain, according to Larson. Following stem cell transplant, Larson questions whether maintenance should be lenalidomide (Revlimid) alone, ixazomib (Ninlaro) alone, or a combination of agents. Additionally, should there be MRD testing with maintenance therapy, similar to testing after stem cell transplant?

Ongoing trials have potential to answer some of these questions regarding the frontline setting in transplant-eligible multiple myeloma. For example, the phase II GRIFFIN trial, which compares lenalidomide/bortezomib (Velcade)/dexamethasone with lenalidomide/bortezomib/dexamethasone/daratumumab (Darzalex), has promising preliminary data for the daratumumab arm, but further data are necessary before determining if it is practice-changing, explains Larson. Another trial Larson is awaiting the results of examines carfilzomib (Kyprolis)/lenalidomide/dexamethasone versus bortezomib/lenalidomide/dexamethasone.

For transplant-ineligible patients with multiple myeloma, the MAIA trial, which examined daratumumab/lenalidomide/dexamethasone versus lenalidomide/dexamethasone alone, shed some light on the frontline treatment setting and led to the approval of daratumumab for that patient population, concludes Larson.

Sarah M. Larson, MD, discusses potentially practice-changing studies for patients with transplant-eligible and -ineligible multiple myeloma.

Sarah M. Larson, MD

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