Single-Agent Lenalidomide Maintenance After Upfront Autologous Stem Cell Transplant for Newly Diagnosed Multiple Myeloma: The MD Anderson Experience

Authors

Oren Pasvolsky
Denái R Milton
Adeel Masood
Sophiya S Sami
Mark R Tanner
Qaiser Bashir
Samer Srour
Neeraj Saini
Paul Lin
Jeremy Ramdial
Yago Nieto
Arsalan Saeed
Hans C Lee
Krina K Patel
Partow Kebriaei
Sheeba K Thomas
Donna M Weber
Robert Z Orlowski
Elizabeth J Shpall
Richard E Champlin
Muzaffar H Qazilbash

Publication Date

10-1-2023

Journal

American Journal of Hematology

Abstract

The optimal duration of lenalidomide (Len) maintenance for patients with multiple myeloma (MM) after autologous stem cell transplantation (autoHCT) is unknown. We conducted a retrospective single-center analysis of adult MM patients that received upfront autoHCT between 2005 and 2021, followed by single-agent Len maintenance. A total of 1167 patients were included with a median age of 61.4 (range 25.4-82.3) years, and high-risk chromosomal abnormalities in 19%. Median duration of maintenance was 22.3 (range 0.03-139.6) months. After a median follow-up of 47.9 (range 2.9-171.7) months, median PFS and OS for the entire cohort were 56.6 (95% CI 48.2-61.4) months and 111.3 (95% CI 101.7-121.5) months, respectively. In MVA, high-risk cytogenetics was associated with a worse PFS (HR 1.91) and OS (HR 1.73) (p < .001 for both). Use of KRD induction and achievement of MRD-negative ≥ VGPR before autoHCT were associated with an improved PFS (HR 0.53 and HR 0.57, respectively; p < .001 for both). Longer maintenance duration, even with a 5-year cutoff, was associated with superior PFS and OS (HR 0.17 and 0.12, respectively; p < .001 for both). A total of 106 patients (9%) developed a second primary malignancy (SPM), mostly solid tumors (39%) and myeloid malignancies (30%). Longer maintenance duration was associated with a higher risk of SPM, reaching statistical significance after >2 years (odds ratio 2.25; p < .001). In conclusion, outcomes with Len maintenance were comparable to those reported in large clinical trials. Longer duration of maintenance, even beyond 5 years, was associated with improved survival.

Keywords

Adult, Humans, Middle Aged, Aged, Aged, 80 and over, Multiple Myeloma, Lenalidomide, Hematopoietic Stem Cell Transplantation, Retrospective Studies, Antineoplastic Combined Chemotherapy Protocols, Transplantation, Autologous, Stem Cell Transplantation, Dexamethasone

Comments

Supplementary Materials

Data Availability Statement

PMID: 37461327