Dr. Bianchi on Shifting Landscape of Transplant Eligible Myeloma

Giada Bianchi, MD, physician, Dana-Farber Cancer Institute, instructor in medicine, Harvard Medical School, discusses treatment options for transplant eligible patients with multiple myeloma.

One of the most exciting advances made in the field has been the incorporation of daratumumab (Darzalex) in the frontline setting in combination with either bortezomib (Velcade), lenalidomide (Revlimid), and dexamethasone (RVd), or carfilzomib (Kyprolis), lenalidomide, and dexamethasone, says Bianchi.

Preliminary data from the phase II GRIFFIN study, which is comparing the use of daratumumab/RVd with that of RVd in the frontline setting, is showing high potency with deep and frequent responses that are achieved relatively early on, she adds. Importantly, the regimen is inducing high rates of minimal residual disease (MRD) negativity early on in treatment.

With these advances, the field is moving toward developing a better understanding on how to incorporate transplant into the treatment of patients who achieve deep remissions with chemotherapy alone, explains Bianchi.

In addition, there are data from the phase II, multicenter FORTE study, which is comparing 12 cycles of continuous therapy of carfilzomib, lenalidomide, and dexamethasone (KRd) with KRd/transplant with carfilzomib, cyclophosphamide, and dexamethasone. Both arms that contain the immunomodulatory drugs, the transplant arm and nontransplant arm of KRd, have been found to be superior to the cyclophosphamide arm. Notably, continuous therapy with KRd is performing as well as KRd and transplant.

To date, there is no statistically significant difference in the overall response rate, depth of response, or MRD negativity in this trial. This raises the question of whether patients in first remission need a transplant if they have received highly active frontline therapy. If not, patients may be able to delay transplant until second remission, concludes Bianchi.