The Induction for Newly Diagnosed Myeloma session, chaired by Dr. Philippe Moreau, covered a wide range of topics, starting with a comprehensive introduction on the specific challenges associated with the management of the disease in this setting. The challenges associated with the treatment of elderly and frail patients were presented and the role of autologous stem cell transplantation (ASCT) as part of the primary therapy in eligible patients was dicussed in view of the most recent data. Beyond induction, the challenges of consolidation and maintenance (regimen type, duration) remain a topic of intense discussion and controversy.
The four abstracts on the topic revealed the challenges in the management of newly diagnosed patients. Dr. Andrzej Jakubowiak presented the first results of the ATLAS study that compared a more intense KRd-based consolidation and maintenance versus the standard lenalidomide only maintenance after ASCT. This intensive maintenance approach was associated with longer PFS, but did not seem to benefit more high-risk patients. It requires frequent hospital visits and has more toxicity; however, the follow up of the study is still rather short. Dr. Philippe Moreau presented the long-term outcomes of the MAIA study that compared lenalidomide and dexamethasone with and without daratumumab (DRd vs Rd), in elderly non-transplant eligible patients. The study showed that D-Rd improves both PFS and OS. Patients who stopped D-Rd before 18 months due to non-progression causes did not do as well, but among patients in deep responses that discontinued after the 18-month mark, the outcomes were still quite good. Dr. Alissa Visram presented data on the impact of marginalization on treatment receipt and overall survival in newly diagnosed MM patients in newly diagnosed patients, based on data from Ontario, Canada. Dr. Paul Richardson presented the results of the DETERMINATION study which questioned the role of ASCT in newly diagnosed, eligible patients who received triplet induction with VRd and lenalidomide maintenance until progression or toxicity and focused on the outcomes by cytogenetics risk. ASCT was associated with significant PFS benefit, but in high-risk patients there was ~90% increase in the risk of progression in those that did not receive ASCT, further emphasizing the role transplant in this patient population.
The abstract presentations were followed by a discussion by Dr. Thierry Facon. Dr. Maria-Victoria Mateos explored the unmet needs and future questions in the management for newly diagnosed MM patients. A lively roundtable discussion included Drs. Keith Stewart, Paul Richardson, Morie Gertz, Sonja Zweegman and Gordon Cook further covered the various aspects of the disease in this setting.