Frontline therapy for newly diagnosed patients with multiple myeloma

Sung-Hoon Jung; Jae-Cheol Jo; Ga-Young Song; Seo-Yeon Ahn; Deok-Hwan Yang; Jae-Sook Ahn; Hyeoung-Joon Kim; Je-Jung Lee

doi:10.5045/br.2020.S007

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Blood Res 2020; 55(S1):

Published online July 31, 2020

https://doi.org/10.5045/br.2020.S007

Frontline therapy for newly diagnosed patients with multiple myeloma

Sung-Hoon Jung¹, Jae-Cheol Jo², Ga-Young Song¹, Seo-Yeon Ahn¹, Deok-Hwan Yang¹, Jae-Sook Ahn¹, Hyeoung-Joon Kim¹, Je-Jung Lee¹

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¹Department of Hematology-Oncology, Chonnam National University Hwasun Hospital, Hwasun, ²Department of Hematology and Oncology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea

Correspondence to : Je-Jung Lee, M.D., Ph.D.
Department of Hematology-Oncology, Chonnam National University Hwasun Hospital, 322 Seoyangro, Hwasun 58128, Korea
E-mail: drjejung@chonnam.ac.kr

Received: November 13, 2019; Revised: January 22, 2020; Accepted: January 30, 2020

This is an Open Access article distributed unAcute myeloid leukemia, New FDA approvalsder the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Abstract

Since the introduction of an alkylator to the treatment of multiple myeloma (MM), new effective agents have been developed, such as immunomodulatory drugs including thalidomide, lenalidomide, and pomalidomide; proteasome inhibitors including bortezomib, carfilzomib, and ixazomib; monoclonal antibodies including daratumumab and elotuzumab; and deacetylase inhibitors including panobinostat. Numerous regimens with these new agents have been developed and they have contributed in improving survival outcomes in MM patients. In addition, the recommended therapies for newly diagnosed MM change every year based on the results of clinical trials. This review will discusses the appropriate induction therapies based on recent clinical trials for patients with newly diagnosed MM.

Keywords Multiple myeloma, Induction therapy, Prognosis

Article

Review Article

Blood Res 2020; 55(S1): S37-S42

Published online July 31, 2020 https://doi.org/10.5045/br.2020.S007

Frontline therapy for newly diagnosed patients with multiple myeloma

Sung-Hoon Jung¹, Jae-Cheol Jo², Ga-Young Song¹, Seo-Yeon Ahn¹, Deok-Hwan Yang¹, Jae-Sook Ahn¹, Hyeoung-Joon Kim¹, Je-Jung Lee¹

Correspondence to:Je-Jung Lee, M.D., Ph.D.
Department of Hematology-Oncology, Chonnam National University Hwasun Hospital, 322 Seoyangro, Hwasun 58128, Korea
E-mail: drjejung@chonnam.ac.kr

Received: November 13, 2019; Revised: January 22, 2020; Accepted: January 30, 2020

Abstract

Keywords: Multiple myeloma, Induction therapy, Prognosis

Abstract

Table 1 . Summary of major recent clinical trials in transplant-eligible patients with newly diagnosed multiple myeloma..

Ref.	Regimen	Cycle of induction	N	CR rate prior to transplant	Median PFS	Median OS
Cavo et al. [28]	VTD vs.	3	236	19%	3-year PFS; 68%	3-year OS; 86%
Cavo et al. [28]	TD	3	238	5%	vs. 56%	vs. 84%
Rosiñol et al. [29]	VTD vs.	6	130	35%	56.2 mo	4-year OS; 74%
	TD vs.		127	14%	28.2 mo	vs. 70%
	VBMCP/VBAD/B		129	0.21	35.3 mo	vs. 65%
Moreau et al. [31]	VTD vs.	4	169	13%	NA	NA
Moreau et al. [31]	VCD	4	169	8.9%	NA	NA
Rosiñol et al. [33]	VRD	6	458	33.4%	NA	NA
Moreau et al. [37]	D-VTD vs.	4	543	39%	18 mo PFS; 93%	NA
Moreau et al. [37]	VTD	4	542	26%	vs. 85%	NA

Abbreviations: CR, complete response; D-VTD; daratumumab, bortezomib, thalidomide, and dexamethasone; NA, not evaluable; OS, overall survival; PFS, progression-free survival; Ref, reference; TD, thalidomide and dexamethasone; VBMCP/VBAD, vincristine, VCD, bortezomib, cyclophosphamide, and dexamethasone; VRD, bortezomib, lenalidomide, and dexamethasone; VTD, bortezomib, thalidomide, and dexamethasone..

Table 2 . Summary of major recent clinical trials in transplant-ineligible patients with newly diagnosed multiple myeloma..

Ref.	Regimen	Cycle of induction	N	CR rate	Median PFS	Median OS
San Miguel et al. [38]	VMP vs.	9	344	30%	19.9 mo	Not reached
San Miguel et al. [38]	MP	9	338	4%	13.1 mo	43.1 mo
Facon et al. [40]	KMP vs.	9	478	25.9%	22.3 mo	NA
Facon et al. [40]	VMP	9	477	23.1%	22.1 mo	NA
Facon et al. [41]	Rd continuous vs.	Continuous	535	0.22	26.0 mo	59.1 mo
	MPT18 vs.	18	541	12%	21.9 mo	49.1 mo
	Rd18	18	547	20%	21.0 mo	62.3 mo
O’Donnell et al. [43]	VRD lite	9	50	44%	35.1 mo	NA
Facon et al. [44]	DRd vs.		368	47.6%	Not reached	NA
Facon et al. [44]	Rd		369	24.9%	31.9 months	NA
Mateos et al. [45]	D-VMP vs.	9	350	42.6%	Not reached	NA
Mateos et al. [45]	VMP	9	356	24.4%	18.1 mo	NA

Abbreviations: CR, complete response; DRd, daratumumab, lenalidomide, and dexamethasone; D-VMP, daratumumab, bortezomib, melphalan, and prednisone; MP, melphalan and prednisone; MPT, melphalan, prednisone, and thalidomide; NA, not available; OS, overall survival; PFS, progression-free survival; Rd, lenalidomide and dexamethasone; Ref, reference; VMP, bortezomib, melphalan, and prednisone; VRD, bortezomib, lenalidomide, and dexamethasone..