TREATMENT CHOICES AND OUTCOMES FOR PATIENTS WITH MULTIPLE MYELOMA AFTER RELAPSE ON LENALIDOMIDE MAINTENANCE THERAPY: RESULTS FROM THE CONNECT® MM REGISTRY
Author(s): ,
Sundar Jagannath
Affiliations:
Mount Sinai Hospital,New York,United States
,
Mohit Narang
Affiliations:
US Oncology Research,Columbia,United States
,
Sikander Ailawadhi
Affiliations:
Mayo Clinic,Jacksonville,United States
,
Robert M. Rifkin
Affiliations:
Rocky Mountain Cancer Centers US Oncology,Denver,United States
,
Howard R. Terebelo
Affiliations:
Providence Cancer Institute,Southfield,United States
,
Kathleen Toomey
Affiliations:
Steeplechase Cancer Center,Somerville,United States
,
Brian G.M. Durie
Affiliations:
Cedars-Sinai Medical Center,Los Angeles,United States
,
James W. Hardin
Affiliations:
University of South Carolina,Columbia,United States
,
Cristina J. Gasparetto
Affiliations:
Duke University Medical Center,Durham,United States
,
Lynne Wagner
Affiliations:
Wake Forest School of Medicine,Winston-Salem,United States
,
James Omel
Affiliations:
Myeloma Research Advocate/Advisor,Grand Island,United States
,
Shankar Srinivasan
Affiliations:
Celgene Corporation,Summit,United States
,
Amani Kitali
Affiliations:
Celgene Corporation,Summit,United States
,
Amit Agarwal
Affiliations:
Celgene Corporation,Summit,United States
Rafat Abonour
Affiliations:
Indiana University,Indianapolis,United States
EHA Library. Jagannath S. Jun 15, 2019; 267001; PS1384
Prof. Dr. Sundar Jagannath
Prof. Dr. Sundar Jagannath
Contributions
Abstract

Abstract: PS1384

Type: Poster Presentation

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

Location: Poster area

Background
Treatment for relapsed multiple myeloma (MM) has evolved with the availability of many novel agents; outcomes in patients with newly diagnosed MM have improved with IMiD agents (lenalidomide [R] or pomalidomide) and proteasome inhibitor (PI) use. Regardless of transplant, many patients receive R maintenance therapy. However, there is a lack of data about the nature of relapse and treatment choices for patients progressing on R maintenance therapy. The Connect MM Registry is a US, multicenter, prospective observational cohort study designed to examine diagnostic and treatment patterns, clinical outcomes and quality of life in mostly community-based (84% of sites) patients with MM.

Aims
To describe nature of relapse, second-line (2L) treatment choice, and outcomes in patients progressing on R maintenance therapy using Connect MM Registry data.

Methods
Adult patients ≤ 60 d from MM diagnosis were enrolled from 250 sites, (N = 3011), treated at physicians’ discretion, and followed up for treatment and outcomes until death, early discontinuation or study end. Transplant-eligible and -ineligible patients who relapsed during R maintenance therapy (≤ 15 mg; assessed by treating physician), were analyzed for baseline (BL) characteristics, nature of relapse, and 2L treatment. Patients with symptoms at time of relapse (symptomatic) were defined by the presence of ≥ 1 CRAB (hyperCalcemia, Renal failure, Anemia, and Bone disease) criterion ± 60 d from progressive disease (PD); nonsymptomatic relapse was the absence of CRAB criteria at PD. Primary endpoint was progression-free survival (PFS) and secondary endpoints were overall survival (OS) and safety (serious adverse events; SAEs); all from start of 2L. Logistic regression analyses on all BL factors and factors before start of 2L treatment were performed to identify covariates differentiating comparator groups. Survival outcomes were analyzed using a Cox regression after adjusting for covariates.

Results
Data cutoff: 1/15/18. Of 2939 treated patients, 1109 entered 2L, 234 having received R maintenance therapy in 1L. Of those patients, 52% (n = 122) and 48% (n = 112) experienced symptomatic and nonsymptomatic relapse, respectively. Median duration of prior maintenance therapy (369 d [IQR: 565]  vs 488 d [IQR: 585]) and time from first progression to start of 2L treatment (0.3 vs 0.3 mo) did not differ notably between nature of relapse groups. A PFS benefit was seen for patients receiving triplet+ (≥ 3 agents; n = 112) vs doublet- (≤ 2 agents; n = 122) regimens (15.0 vs 9.0 mo; HR: 0.68) from start of 2L. PFS and OS were better for patients receiving regimens containing IMiD agent + PI vs PI (without IMiD agents) in 2L (PFS: HR, 0.67; Figure; OS: 44.3 vs 25.8 mo; HR, 0.53). SAEs rates were similar among treatment groups: 43%, 35%, and 33% with IMiD agent + PI (n = 61), IMiD agent (without PI; n = 57), and PI (n = 102), respectively.

Conclusion
This is the first description of relapse patterns, 2L treatment choice and survival outcomes after PD on R maintenance therapy in community-based patients. Similar numbers of patients had symptomatic or nonsymptomatic relapse. After PD on R maintenance, ~50% of patients switched to PI, 25% received IMiD agent + PI, and 25% recieved IMiD agent. Our data show PFS benefit for triplet+ over doublet- treatment in 2L. Patients in the IMiD agent + PI group gained PFS and OS benefits over patients in the PI group. Characterization of patients in the IMiD agent group are ongoing. These data may be used to better inform treatment choices after relapse on R maintenance therapy.

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

Keyword(s): Maintenance, Multiple myeloma, Relapse, Treatment

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