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Lenalidomide maintenance appears superior to bortezomib-based maintenance after autologous stem cell transplant (ASCT) in certain patients with high-risk multiple myeloma (MM), according to a study presented at the Tandem Meetings 2022.
Among all patients with high-risk MM, there were no significant differences in progression-free survival (PFS) or overall survival (OS) between patients who received lenalidomide maintenance and those who received bortezomib-based maintenance.
However, among patients with any abnormality at chromosome 1q (Abn1q), lenalidomide was associated with superior PFS and OS.
This retrospective study included 503 patients with high-risk MM who underwent ASCT within 12 months of diagnosis. There were 357 patients who received maintenance with lenalidomide alone and 146 who received bortezomib-based maintenance. Bortezomib-based maintenance included bortezomib monotherapy (n=85), bortezomib plus lenalidomide (n=58), and bortezomib plus another therapy (n=2).
The median age at diagnosis was 61 years in both treatment groups (overall range, 34-79 years). Men made up 45% of the bortezomib group and 55% of the lenalidomide group, and Abn1q was seen in 50% and 60% of patients, respectively.
The most common induction regimens (in the bortezomib and lenalidomide groups, respectively) were bortezomib plus lenalidomide and dexamethasone (67% and 82%) and bortezomib plus cyclophosphamide and dexamethasone (29% and 17%). Prior to transplant, most patients in each group had a very good partial response (VGPR) or better (59% and 60%).
The best response after ASCT was similar between the groups. The VGPR rate was 28% in the bortezomib group and 30% in the lenalidomide group. The rate of complete response (CR) or stringent CR was 53% and 55%, respectively.
In a multivariate analysis, there was no significant difference between the treatment groups for PFS (hazard ratio [HR], 1.28; 95% CI, 0.76-2.16; P =.355) or OS (HR, 2.08; 95% CI, 0.82-5.27; P =.123) in the overall cohort.
However, among patients with Abn1q, those who received bortezomib-based maintenance had significantly worse PFS (HR, 1.93; 95% CI, 1.20-3.13; P =.007) and OS (HR, 3.21; 95% CI, 1.34-7.70; P = .0092) than patients who received lenalidomide maintenance.
Disclosures: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.
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Bumma N, Dhakal B, Fraser R, et al. Impact of bortezomib-based vs. lenalidomide maintenance therapy on outcomes of patients with high-risk multiple myeloma. Tandem Meetings 2022; April 23-26, 2022. Abstract 13.