RT Journal Article
T1 Curative Strategy for High-Risk Smoldering Myeloma: Carfilzomib, Lenalidomide, and Dexamethasone (KRd) Followed by Transplant, KRd Consolidation, and Rd Maintenance
A1 Mateos, María-Victoria
A1 Martínez-López, Joaquin
A1 Rodriguez Otero, Paula
A1 González-Calle, Verónica
A1 Gonzalez, Marta Sonia
A1 Oriol, Albert
A1 Gutiérrez, Norma C
A1 Ríos-Tamayo, Rafael
A1 Rosiñol, Laura
A1 Alvarez Rivas, Miguel Angel
A1 Bargay Lleonart, Joan
A1 Gonzalez-Rodriguez, Ana Pilar
A1 Alegre, Adrián
A1 Escalante, Fernando
A1 Iñigo Rodríguez, María Belén
A1 de la Rubia, Javier
A1 Teruel, Ana Isabel
A1 de Arriba, Felipe
A1 Palomera, Luis
A1 Hernández, Miguel T
A1 Lopez Jiménez, Javier
A1 Reinoso-Segura, Marta
A1 García Mateo, Aránzazu
A1 Ocio, Enrique M
A1 Paiva, Bruno
A1 Puig, Noemi
A1 Cedena, Maria Teresa
A1 Bladé, Joan
A1 Lahuerta, Juan Jose
A1 San-Miguel, Jesus F
AB Early treatment of high-risk smoldering myeloma has been shown to delay progression to multiple myeloma (MM). We conducted this trial with curative intention using a treatment approach employed for newly diagnosed patients with MM.Patients with high-risk smoldering myeloma (>50% progression risk at 2 years) and transplant candidates were included and received induction therapy with carfilzomib, lenalidomide, and dexamethasone (KRd), six cycles, followed by high-dose melphalan (200 mg/m2) autologous stem-cell transplantation (HDM-ASCT), two KRd consolidation cycles, and Rd maintenance for 2 years. The primary end point was undetectable measurable residual disease (uMRD) rate by next-generation flow after ASCT. Sustained uMRD 4 years after ASCT was the secondary end point.Between June 2015 and June 2017, 90 patients were included, and 31% met at least one SixtyLightchain MRI (SLiM)-hypercalcemia, renal impairment, anemia, bone disease (CRAB) criterion. After a median follow-up of 70.1 months, 3 months after ASCT, in the intention-to-treat population, 56 (62%) of 90 patients had uMRD, and 4 years later, it was sustained in 29 patients (31%). Five patients progressed to MM, and the 70-month progression rate was 94% (95% CI, 84 to 89). The presence of any SLiM CRAB criteria predicted progression to MM (four of the five patients; hazard ratio, 0.12; 95% CI, 0.14 to 1.13; P = .03). Thirty-six patients showed biochemical progression, and failure to achieve uMRD at the end of treatment predicted it. The 70-month overall survival was 92% (95% CI, 82 to 89). Neutropenia and infections were the most frequent adverse events during treatment, resulting in one treatment-related death. Three second primary malignancies have been reported.Although a longer follow-up is needed, this curative approach is encouraging and more effective than active MM, with 31% of the patients maintaining the uMRD 4 years after HDM-ASCT.
PB ASCO Publications
YR 2024
FD 2024-09-20
LK https://hdl.handle.net/20.500.13003/21129
UL https://hdl.handle.net/20.500.13003/21129
LA eng
NO Mateos MV, Martínez-López J, Rodriguez Otero P, González-Calle V, Gonzalez MS, Oriol A, et al. Curative Strategy for High-Risk Smoldering Myeloma: Carfilzomib, Lenalidomide, and Dexamethasone (KRd) Followed by Transplant, KRd Consolidation, and Rd Maintenance. J Clin Oncol. 2024 Sep 20;42(27):3247–56.
DS Docusalut
RD 2 sept. 2026