Ixazomib and lenalidomide maintenance therapy in multiple myeloma
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LETTER TO THE EDITOR
Ixazomib and lenalidomide maintenance therapy in multiple myeloma Ricardo D. Parrondo 1 & Victoria Alegria 1 & Vivek Roy 1 & Taimur Sher 1 & Asher A. Chanan-Khan 1 & Sikander Ailawadhi 1 Received: 19 October 2020 / Accepted: 3 November 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Dear Editor, Multiple myeloma (MM) is an incurable plasma cell neoplasm that accounts for 10% of all hematologic malignancies [1]. Induction therapy with bortezomib (V), lenalidomide (R), and dexamethasone followed by autologous hematopoietic cell transplantation (AHCT) is the standard of care for most transplant-eligible patients conferring a median progression-free survival (mPFS) of 50 months [2]. The current standard of care following AHCT for prolonged remission and relapse prevention is R maintenance therapy based on three prospective randomized trials [3–5] and a meta-analysis [6] demonstrating that R maintenance following AHCT prolongs PFS and overall (OS) survival. While these trials showed an unclear survival advantage for patients with high-risk (HR) cytogenetics or renal dysfunction, the Myeloma XI trial showed a PFS benefit of R maintenance for patients with HR cytogenetics [7]. Proteasome inhibitor (PI)–based maintenance strategies with V and ixazomib (I) have also shown efficacy in the postAHCT maintenance setting [8]. Nonetheless, relapse is inevitable following AHCT. Novel maintenance strategies are urgently needed to prolong remission duration and provide a functional cure for patients with MM. We performed a retrospective chart review of patients with MM treated with I between January 2015 and August 2020. Sixty-one patients were identified, 9 of which were treated with the combination of IR in the
* Sikander Ailawadhi [email protected] 1
Deparment of Hematology-Oncology, Mayo Clinic Florida, Mangurian Building, 3rd Floor, 4500 San Pablo Road S, Jacksonville, FL 32224, USA
maintenance setting. The median age of patients at IR maintenance initiation was 60 years (range 32–73), 6 patients were male, eight patients were white, and one patient had plasma cell leukemia (PCL). Four patients had HR cytogenetics. Three patients were refractory to V and two were refractory to R. Two patients had prior exposure to the IR combination. Seven patients received IR in the post-AHCT setting. Patients were treated with a median of 2 lines of therapy prior to AHCT (induction therapy = 1 line, range 1–6). Other baseline characteristics are shown in Table 1. The median R dose was 10 mg (range 10–15) and the median I dose was 2.3 mg (range 2.3–4). Treatment was until disease progression. The median follow-up time on IR maintenance was 14 months (95% CI 8–23). The median PFS on IR maintenance was not reached (NR) (95% CI 1-NR). The median time to next treatment was NR (95% CI 3-NR). Four patients have relapsed, including one death due to progressive PCL. The rest remain on IR. One patient had a deepening of response from a partial response to a very good partial response in the post-AHC
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