Author(s): ,
Hartmut Goldschmidt
Internal Medicine,University Clinic Heidelberg,Heidelberg,Germany
Gordon Cook
Leeds Cancer Centre,St James's University Hospital,Leeds,United Kingdom
Philippe Moreau
Hematology,University Hospital Hotel-Dieu,Nantes,France
Clara Chen
Hematology,Bristol-Myers Squibb Company,Princeton,United States
Catherine Davis
Hematology,Bristol-Myers Squibb Company,Princeton,United States
EHA Library. Moreau P. Jun 15, 2019; 267022; PS1405
Prof. Philippe Moreau
Prof. Philippe Moreau

Abstract: PS1405

Type: Poster Presentation

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

Location: Poster area

Most patients (pts) with multiple myeloma (MM) will eventually relapse and become refractory to lenalidomide and proteasome inhibitors (PIs). Pomalidomide plus dexamethasone (Pd) is indicated for pts with MM who have received at least two prior therapies including lenalidomide and a PI; however, responses are not durable and median overall survival is about 1 year.1The use of Pd triplets has been shown to improve outcomes for relapsed/refractory MM (RRMM) pts,2,3and the combination of a monoclonal antibody (mAb) and Pd additionally increases duration of response.4,5

To understand the use of pomalidomide-based regimens in RRMM pts in four European countries. 

Adult pts with RRMM from Europe (France, Germany, Italy, and the UK) were identified from PREAMBLE (NCT01838512), an ongoing, international, prospective, observational study. Pts had ≥1 prior therapy and initiated treatment with a PI, immunomodulatory drug(IMiD), IMiD+PI, or newer agent (mAbs, histone deacetylase inhibitors, Akt inhibitors, or novel combinations) 90 days before and 30 days after informed consent, and were followed for up to 3 years. Data were summarized using descriptive statistics. 

Data were available for 824 pts (median [range] follow-up was 14.0 months [7.3, 25.8]; median age of 70 years at enrollment, with an approximately equal distribution across enrolling countries [Table]). At data cutoff (April 27, 2018), 425 (51.6%) RRMM pts were still in the study. Of 824 pts receiving treatment at enrollment, 54.1% (n=446), 36.3% (n=299), and 6.6% (n=54) were treated with IMiD, PI, and IMiD+PI, respectively (Table). Among pts receiving IMiD-based regimens (n=500), 71 (14.2%) pts received Pd-based regimens (90.1% Pd and 9.9% Pd triplets). The proportion of pts treated with an IMiD was similar with increasing line of therapy: 39.1% (n=322/824), 46.9% (n=279/595), 44.3% (n=170/384), 45.6% (n=110/241), 36.3% (n=157/433) of pts were treated with IMiD in the second-line (2L), third-line (3L), fourth-line (4L), fifth-line (5L), and sixth-line (6L) setting and above. The proportion of pts receiving Pd increased with increasing line of therapy, whereas that for Pd-based triplets decreased: 4.6% (n=17; 64.7% Pd and 35.3% Pd triplets), 14.5% (n=45; 93.3% Pd and 6.7% Pd triplets), 27.5% (n=52; 94.2% Pd and 5.8% Pd triplets), 34.5% (n=41; 95.1% Pd and 4.9% Pd triplets), and 39.9% (n=69; 98.6% Pd and 1.4% Pd triplets) of pts received Pd-based regimens in 2L, 3L, 4L, 5L, and 6L and above, respectively. The proportion of pts receiving newer agents also increased with increasing line of therapy: 1.3% (n=11), 2.7% (n=16), 3.6% (n=14), 6.2% (n=15), and 10.6% (n=46) received newer agentsin 2L, 3L, 4L, 5L, and 6L and above, respectively. 

In France, Germany, Italy, and the UK, Pd-based regimens were rarely used as 2L therapy; however, the proportion of pts receiving these regimens increases with increasing line of therapy, and Pd or Pd-based triplets are used in more than a quarter of pts in 3L and above. Only a small proportion of pts received Pd-based triplets, particularly in 3L and above, and given the aforementioned durable improvement in outcomes conferred by these triplets, they may be an option for RRMM pts who have received at least two prior therapies and are refractory to lenalidomide and PIs.

1. Dimopoulos MA, et al. Blood 2016;128(4):497-503 2. Richardson PG, et al. EHA 2018;S847 3. Vij R, et al. EHA 2018;PF573 4. Dimopoulos MA, et al. N Engl J Med 2018;379(19):1811-1822 5. Chari A, et al. Blood 2017;130(8):974-981

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

Keyword(s): Multiple myeloma

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