For newly diagnosed patients with multiple myeloma, consolidation treatment with bortezomib, lenalidomide, and dexamethasone followed by lenalidomide maintenance showed greater progression-free survival improvement and depth of response compared to maintenance treatment alone.

“The role of consolidation treatment in multiple myeloma has not been conclusively established,” Pieter Sonneveld, Erasmus MC Cancer Institute, and his colleagues wrote in the Journal of Clinical Oncology. “The results show that consolidation plus maintenance after either bortezomib, melphalan, and prednisone or high-dose melphalan, autologous stem-cell transplantation deepens the response and significantly improves the progression-free survival (PFS) in comparison with maintenance alone.”

The EMN02/HOVON95 trial was a randomized, phase III trial that compared consolidation treatment with two cycles of bortezomib, lenalidomide, and dexamethasone (VRD) or no consolidation after induction and intensification therapy, followed by continuous lenalidomide maintenance. Progression-free survival (PFS) was the primary end point.

A total of 878 patients were randomly assigned to receive VRD consolidation (n=451 patients) or no consolidation (n=427 patients). At a median follow-up of 74.8 months, the median PFS of patients randomly assigned to VRD consolidation was 59.3 months compared to the 42.9 months PFS in patients with no consolidation (hazard ratio [HR] = 0.81; 95% CI, 0.68 to 0.96; P = .016). This benefit was seen across most predefined subgroups including cytogenetics and prior treatment.

The median duration of maintenance was 33 months. Before the start of maintenance, the response rate was 34% after consolidation versus 18% no consolidation, respectively (P < .001). The response rate on protocol including maintenance was 59% with consolidation and 46% without (P < .001). A subgroup of 226 patients with complete response, stringent complete response, or very good partial response before start of maintenance demonstrated a 74% minimal residual disease–negativity rate in VRD-treated patients. The toxicity from VRD was deemed acceptable and manageable.


By Alexa Josaphouitch, Staff Writer

 
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