NOVEL trial results show a more effective treatment route for newly diagnosed multiple myeloma. The DETERMINATION trial found that newly diagnosed patients with multiple myeloma who are administered triplet of drugs (namely lenalidomide, bortezomib, and dexamethasone [RVD]), have a longer progress-free survival (PFS) if they receive autologous stem cell transplant following the drug regimen, compared with just undergoing stem cell collection for future transplant.
The study, presented at the American Society of Clinical Oncology (ASCO) 2022 annual congress, involved 873 patients randomly assigned to either an RVD-only group or a transplantation group. All patients were administered one cycle of RVD before randomisation, then two additional RVD cycles and stem-cell mobilisation; however, patients in the RVD-only group had five additional RVD cycles, while patients in the transplantation group received high-dose melphalan and autologous stem cell transplant followed by two additional RVD cycles. Lenalidomide was also administered to all patients until disease progression and/or the presentation of severe side effects. The authors found that patients who received RVD only had a 53% higher risk of disease progression or death at a median follow-up period of 76.0 months, while the transplantation group also displayed a longer PFS, with a median duration of 55.5 months compared with 17.1 months for the RVD-only group.
Commenting on the importance of these results, first author Paul Richardson, Professor of Medicine, Harvard Medical School, Cambridge, USA, noted: “Our findings confirm the PFS benefit of transplantation as first-line treatment for patients with myeloma and confirms stem cell transplant as a standard of care with certain triplet therapy.” He went on to explain: “Our study provides important information about the benefits of transplant in the era of highly effective novel therapies and continuous maintenance, as well as the potential risks, to help patients and their physicians decide what approach may be best for them. This is particularly relevant as we have now further improved the induction treatment for younger patients with newly diagnosed myeloma using quadruplet regimens incorporating monoclonal antibodies, such as RVD combined with daratumumab.”