LENALIDOMIDE MAINTENANCE POSITIVELY IMPACTS OUTCOMES IN MULTIPLE MYELOMA WITHOUT NEGATIVE IMPACTS IN RELAPSE: AN ANALYSIS OF REAL WORLD DATA FROM THE MYELOMA CANADA RESEARCH NETWORK NATIONAL DATABASE
Author(s): ,
Hannah Cherniawsky
Affiliations:
Faculty of Medicine and Dentisty, Department of Medicine,University of Alberta,Edmonton,Canada
,
Vishal Kukreti
Affiliations:
Medical Oncology and Hematology,Princess Margaret Cancer Centre,Toronto,Canada
,
Donna Reece
Affiliations:
Medical Oncology and Hematology,Princess Margaret Cancer Centre,Toronto,Canada
,
Esther Masih-Khan
Affiliations:
Myeloma Canada Research Network,Toronto,Canada
,
Arleigh McCurdy
Affiliations:
The Ottawa Hospital,Ottawa,Canada
,
Victor Jimenez-Zepeda
Affiliations:
Tom Baker Cancer Centre,Calgary,Canada
,
Michael Sebag
Affiliations:
Department of Oncology, Division of Hematology,McGill University,Montreal,Canada
,
Kevin Song
Affiliations:
BC Cancer,Vancouver General Hospital,Vancouver,Canada
,
Darrell White
Affiliations:
Queen Elizabeth II Health Sciences Centre, Dalhousie University,Halifax,Canada
,
Julie Stakiw
Affiliations:
Saskatoon Cancer Centre, University of Saskatchewan,Saskatoon,Canada
,
Richard Leblanc
Affiliations:
Maisonneuve-Rosemont Hospital Research Centre, University of Montreal,Montreal,Canada
,
Anthony Reiman
Affiliations:
Department of Oncology,Saint John Regional Hospital,Saint John,Canada
,
Muhammad Aslam
Affiliations:
Saskatoon Cancer Centre, University of Saskatchewan,Saskatoon,Canada
,
Martha Louzada
Affiliations:
London Regional Cancer Center,London,Canada
,
Rami Kotb
Affiliations:
Cancer Care Manitoba,Winnipeg,Canada
,
Engin Gul
Affiliations:
Myeloma Canada Research Network,Toronto,Canada
,
Eshetu Atenafu
Affiliations:
Myeloma Canada Research Network,Toronto,Canada
Christopher Venner
Affiliations:
Cross Cancer Institute, University of Alberta,Edmonton,Canada
EHA Library. Venner C. Jun 15, 2019; 266993; PS1376
Christopher Venner
Christopher Venner
Contributions
×
Abstract

Abstract: PS1376

Type: Poster Presentation

Presentation during EHA24: On Saturday, June 15, 2019 from 17:30 - 19:00

Location: Poster area

Background
Randomized trials have demonstrated the positive impact of lenalidomide maintenance (LM) on outcomes following autologous stem cell transplant (ASCT) in multiple myeloma (MM). This finding has led to its wide-spread adoption as a standard of care. However, data examining its effect in the real-world setting is lacking. 

Aims
Using the Myeloma Canada Research Network Canadian Multiple Myeloma Database (MCRN CMM-DB) we have examined the impact of LM at a national level.

Methods

We retrospectively reviewed data from patients tracked using the MCRN CMM-DB. This web-based centralized platform characterizes real-world outcomes in patients treated at 13 major Canadian academic institutionsand includes comprehensive data on >6000 patients dating back to 2007 with ongoing prospective data collection. This analysis examined patients treated with bortezomib-based induction therapy prior to ASCT. Subjects were included up until January 2016 to ensure at least 2 years of follow-up. The analysis was performed based on intention-to-treat with LM. Overall survival (OS) was defined as time from pre-ASCT induction therapy to death or last follow-up (F/U). Progression-free survival (PFS) was defined as the time from induction therapy to progression, death or last F/U. We also calculated outcomes of relapsing patients in both arms, including 2nd PFS (from second-line therapy to second relapse, death or last F/U) and PFS2 (time from induction therapy to second relapse, death or last F/U). Lastly, given regional variation in LM dosing schedules, we examined outcomes based on a 21/28 days or continuous 28/28 days dosing strategy.

Results
Data from 1,256 patients across 10 Canadian centers was included (723 with LM and 533 without). Median follow-up in the LM group was 49 months and 45 months in the non-LM group. The median OS was not reached in the LM cohort and 98 months in the non-LM group (p <0.0001, figure 1a). The median PFS also favoured patients treated with LM (58 months versus 35 months respectively, p <0.0001, figure 1b). Response rates were high with 98% achieving ≥PR in the LM group compared to 96% in the non-LM group (p = 0.06). In LM patients 94% achieved ≥VGPR compared to 81% in the non-LM group (p <0.01). At the time of analysis, 45% of LM and 63% of non-LM patients have relapsed. Treatment for relapsed disease resulted in a similar median 2nd PFS between LM vs non-LM patients (12 months vs 16 months respectively, p=0.07, figure 1c). The median PFS2 remained in favour of LM compared with non-LM (not reached vs 68 months, p < 0.01, figure 1d).  Median duration of maintenance therapy was 20.5 months (0.0 - 102.48+). Analysis of patients treated with a 28/28 days (n=356) versus a 21/28 (n=257) days LM dosing schedule showed no difference in estimated 5-year OS (81% and 80% respectively, p = 0.66) or 5-year PFS (47% and 52% respectively, p = 0.75).

Conclusion

Using the MCRN CMM-DB we present one of the largest real-world cohorts demonstrating the dramatic impact on outcomes using LM following bortezomib-based induction. Notable improvements are seen in PFS, OS and depth of response. The truncated 21/28 day dosing strategy did not negatively impact these endpoints. Importantly, LM did not demonstrate a negative effect on the outcomes with second-line therapy, as the median 2nd PFS was similar and the PFS2 remained in favour of LM. Overall, this large real-world cohort supports the ongoing use of LM in the frontline management of MM.

Session topic: 14. Myeloma and other monoclonal gammopathies - Clinical

Keyword(s): Maintenance, Myeloma, Survival

By clicking “Accept Terms & all Cookies” or by continuing to browse, you agree to the storing of third-party cookies on your device to enhance your user experience and agree to the user terms and conditions of this learning management system (LMS).

Cookie Settings
Accept Terms & all Cookies