Contributions
Abstract: PB2201
Type: Publication Only
Background
Prognosis in multiple myeloma (MM) depends on specific patient and disease characteristics, staging and response. Strong evidence supports the quality and duration of the response, in accordance with IMWG criteria, as a key prognostic factor. Therefore, a careful monthly monitoring of response is mandatory, as well as a global evaluation after each phase of the treatment. Outside clinical trials (ct), heterogeneity remains in relation to response evaluation of real-life patients. Even in the setting of population-based MM registries, the response is rarely reported.
Aims
Assessing the evolution of the response to old and current induction regimens.
Methods
The Granada MM Registry is the second largest single-institution population-based registry (Ríos-Tamayo R et al.2015), working since 1985. Evaluation of the response was prospectively recorded since 2012, and retrospectively during the previous period. IMWG criteria have been used, including imaging (PET/CT) and flow minimal residual disease (MRD)(Kumar S et al.2016). All consecutive newly diagnosed MM (NDMM) patients with residence in our reference area, which were considered fit to receive the standard induction regimen at the moment of diagnosis, were included. Overall response rate (ORR) and complete response (CR) rate have been pointed out. When information was not available, the response was informed as unknown/not valuable.
Results
359 NDMM patients have been evaluated in relation to 12 regimens, including two or more drugs: melphalan-prednisone (MP), vincristine-adriamycin-dexamethasone (VAD), V-BCNU-M-cyclophosphamide-P/V-BCNU-A-D (VBMCP/VBAD), bortezomib-D (VD), VMP, VCD, V-lenalidomide-D (VRD), V-thalidomide-D (VTD), bortezomib-A-D (PAD), RD, R-D-clarithromycin (RDC), carfilzomib-R-D (KRD). Table 1 shows the number (n) of patients in each combination, ORR and CR rates. If the regimen has been used in the context of a ct, it has been indicated.
REGIMEN | n | ORR % | CR % | MRD NEG% | UN KNOWN | CLINICAL TRIAL |
MP | 25 | 20 | 4 | - | 44 | N |
VAD | 74 | 50.1 | 4.1 | - | 33.8 | N |
VCMPVBAD | 6 | 66.6 | 33.3 | - | 16.7 | N |
VD | 58 | 58.6 | 19 | 3.5 | 22.4 | N |
VMP | 53 | 52.9 | 18.9 | - | 35.8 | N |
VCD | 97 | 79.3 | 24.7 | 2.1 | 8.3 | N |
VRD | 20 | 95 | 70 | 35 | 5 | Y(18) |
VTD | 3 | 100 | 33.3 | - | 0 | N |
PAD | 4 | 75 | 25 | - | 25 | N |
RD | 9 | 66.7 | 55.6 | 22.2 | 22.2 | Y(3) |
RDC | 4 | 100 | 25 | 25 | 0 | Y |
KRD | 6 | 100 | 66.7 | 33.3 | 0 | Y |
Conclusion
The information about response should be prospectively recorded in MM population-based registries. The retrospective evaluation of response in old regimens is inconclusive due to a high proportion of unknown response. The new triplets, particularly VRD and KRD, whose approval in real-life is still pending, are highly effective as induction. Triplets are more effective than doublets. However, selected patients treated with doublets can achieve CR with MRD negativity. The heterogeneity in response highlights the need to implement a risk-adapted, individualized, and patient-centered therapy.
Session topic: 14. Myeloma and other monoclonal gammopathies - Clinical
Keyword(s): Induction, Multiple Myeloma
Abstract: PB2201
Type: Publication Only
Background
Prognosis in multiple myeloma (MM) depends on specific patient and disease characteristics, staging and response. Strong evidence supports the quality and duration of the response, in accordance with IMWG criteria, as a key prognostic factor. Therefore, a careful monthly monitoring of response is mandatory, as well as a global evaluation after each phase of the treatment. Outside clinical trials (ct), heterogeneity remains in relation to response evaluation of real-life patients. Even in the setting of population-based MM registries, the response is rarely reported.
Aims
Assessing the evolution of the response to old and current induction regimens.
Methods
The Granada MM Registry is the second largest single-institution population-based registry (Ríos-Tamayo R et al.2015), working since 1985. Evaluation of the response was prospectively recorded since 2012, and retrospectively during the previous period. IMWG criteria have been used, including imaging (PET/CT) and flow minimal residual disease (MRD)(Kumar S et al.2016). All consecutive newly diagnosed MM (NDMM) patients with residence in our reference area, which were considered fit to receive the standard induction regimen at the moment of diagnosis, were included. Overall response rate (ORR) and complete response (CR) rate have been pointed out. When information was not available, the response was informed as unknown/not valuable.
Results
359 NDMM patients have been evaluated in relation to 12 regimens, including two or more drugs: melphalan-prednisone (MP), vincristine-adriamycin-dexamethasone (VAD), V-BCNU-M-cyclophosphamide-P/V-BCNU-A-D (VBMCP/VBAD), bortezomib-D (VD), VMP, VCD, V-lenalidomide-D (VRD), V-thalidomide-D (VTD), bortezomib-A-D (PAD), RD, R-D-clarithromycin (RDC), carfilzomib-R-D (KRD). Table 1 shows the number (n) of patients in each combination, ORR and CR rates. If the regimen has been used in the context of a ct, it has been indicated.
REGIMEN | n | ORR % | CR % | MRD NEG% | UN KNOWN | CLINICAL TRIAL |
MP | 25 | 20 | 4 | - | 44 | N |
VAD | 74 | 50.1 | 4.1 | - | 33.8 | N |
VCMPVBAD | 6 | 66.6 | 33.3 | - | 16.7 | N |
VD | 58 | 58.6 | 19 | 3.5 | 22.4 | N |
VMP | 53 | 52.9 | 18.9 | - | 35.8 | N |
VCD | 97 | 79.3 | 24.7 | 2.1 | 8.3 | N |
VRD | 20 | 95 | 70 | 35 | 5 | Y(18) |
VTD | 3 | 100 | 33.3 | - | 0 | N |
PAD | 4 | 75 | 25 | - | 25 | N |
RD | 9 | 66.7 | 55.6 | 22.2 | 22.2 | Y(3) |
RDC | 4 | 100 | 25 | 25 | 0 | Y |
KRD | 6 | 100 | 66.7 | 33.3 | 0 | Y |
Conclusion
The information about response should be prospectively recorded in MM population-based registries. The retrospective evaluation of response in old regimens is inconclusive due to a high proportion of unknown response. The new triplets, particularly VRD and KRD, whose approval in real-life is still pending, are highly effective as induction. Triplets are more effective than doublets. However, selected patients treated with doublets can achieve CR with MRD negativity. The heterogeneity in response highlights the need to implement a risk-adapted, individualized, and patient-centered therapy.
Session topic: 14. Myeloma and other monoclonal gammopathies - Clinical
Keyword(s): Induction, Multiple Myeloma