Micrograph of myeloma neoplasm bony marrow biopsy. New grounds supports the usage of a 3 cause combo—carfilzomib, lenolidomide, and dexamethasone (KRd), for attraction therapy aft autologous stem compartment transplantation successful patients recently diagnosed with multiple myeloma. Maintenance therapy utilizing these 3 drugs whitethorn amended progression-free endurance arsenic compared to azygous cause lenalidomide treatment.
After astir 34 months successful the study, median progression-free endurance for the KRd limb was 59.1 months compared to 41.6 months for the lenalidomide arm. That’s a 49% simplification successful the hazard of progression oregon death. This simplification was contempt a shorter duration (8 cycles) of attraction successful 44% patients connected the KRd arm.
Researchers from the University of Chicago Medicine Comprehensive Cancer Center and colleagues from the Polish Myeloma Consortium study the results, from the ongoing ATLAS trial, this period in Lancet Oncology. The survey was led by Dominik Dytfeld, MD, PhD.
Overall, efficacy and toxicity results were favorable, making KRd a compelling information for post-transplant attraction aft autologous stem-cell transplantation, said Andrzej Jakubowiak, MD, PhD, the Director of the Myeloma Program astatine the University of Chicago and the wide Principal Investigator of the ATLAS study.
Multiple myeloma is caused by rogue plasma cells producing a monoclonal immunoglobulin. These cells proliferate successful the bony marrow and tin origin osteolytic lesions, osteopenia, and fractures. Patients are categorized with standard-risk to high-risk illness based connected fluorescence successful situ hybridization (FISH) and different tests.
Treatment regimens are based connected the signifier of the disease. Those whose information is astir superior are candidates for autologous hematopoietic compartment transplantation. Prior to transplantation, they acquisition “induction therapy,” the extremity of which is to trim the fig of rogue plasma cells anterior to the procedure. The adjacent measurement aft the transplant is attraction therapy.
But, “Many of the preferred attraction options person not been compared straight with each different successful a randomized proceedings successful these diligent populations. As such, determination is nary modular of attraction and antithetic experts usage antithetic regimens,” notes UpToDate successful its latest post connected aggregate myeloma treatment.
As a result, various regimens and ways to usher their usage are presently being evaluated successful a fig of ongoing randomized trials, including ATLAS—a signifier 3 objective survey being conducted astatine 12 world and objective centers successful the United States and Poland.
Between June 2016 and October 2020, this survey enrolled 180 patients who were randomly assigned to person either KRd oregon lenalidomide alone. Eligibility criteria included the completion of transplantation with nary progression wrong 12 months from commencement of pre-transplantation therapy.
The KRd limb received either 8 oregon 36 cycles of KRd attraction based connected minimal residual illness presumption and different risks for progression. Patients with modular hazard illness who achieved MRD-negativity astatine the extremity of 6 cycles of KRd maintenance, received a full 8 cycles of KRd followed by lenalidomide maintenance. The remaining patients continued KRd for 36 cycles followed by lenalidomide maintenance.
The superior endpoint of the survey was progression-free endurance and secondary endpoints included MRD-negativity rates, safety, and tolerability.
Investigators enactment that these interim results are successful enactment with those from the phase 2 FORTE trial, published successful The Lancet successful 2021. That survey reported an betterment successful progression-free survival, successful the attraction signifier of the trial, with summation of carfilzomib to lenalidomide successful examination with lenalidomide alone.
English (US)