Maintenance Regimen After Autologous HCT in Relapsed Multiple Myeloma: Phase II Findings

By: Joshua D. Madera, MD
Posted: Tuesday, January 9, 2024

For patients with relapsed multiple myeloma, combination maintenance therapy with the monoclonal antibody elotuzumab, the immunomodulating agent pomalidomide, and the corticosteroid dexamethasone (EPd) after a second administration of autologous hematopoietic cell transplantation (HCT) is considered a safe therapeutic strategy, according to a study published in Transplantation and Cellular Therapy. However, additional studies are warranted to develop a preferred protocol for its use in this patient population, suggested Michael Slade, MD, MSCI, of Washington University School of Medicine, St. Louis, and colleagues.

“Further studies are needed to define the optimal use of and protocol for a second autologous HCT in fit patients with relapsed multiple myeloma,” the investigators proposed.

A total of 25 patients with histologically confirmed multiple myeloma were recruited for the study. All patients had had an initial autologous HCT and experienced disease progression after treatment. Sixteen patients received induction therapy with four cycles of EPd. After completion of induction therapy, they received standard melphalan-conditioned autologous HCT. A safety analysis was performed, and the study protocol was amended to remove the induction therapy stage as a component of the protocol. Between 80 to 120 days after treatment with autologous HCT, 18 patients received continuous therapy with EPd until treatment intolerance or disease progression. In addition to the combination regimen, they received daily aspirin for venous thromboembolism prophylaxis.

Of the patients who received EPd induction therapy, 38% were unable to have autologous HCT because of disease progression. After the amendment of the treatment protocol, the progression-free survival rate at the 1-year interval and the median progression-free survival duration were 72% and 19 months, respectively. Moreover, treatment was discontinued for two patients because of dose-related toxicities attributed to elotuzumab (n = 1) and pomalidomide (n = 1). 

Disclosure: For full disclosures of the study authors, visit sciencedirect.com.

Transplantation and Cellular Therapy

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