Hello, my name is María Victoria Mateos. I work at the University Hospital of Salamanca in Spain and I am here attending ASS 2024 in San Diego. I will present an update of a Phase 3 clinical study the Spanish Myeloma Group is conducting in transplant ineligible newly diagnosed Myeloma patients with a chronological age up to 80 but the patients have to be fit and we compared the three induction arms Bortezomib Melfalan and Prednisone 9 cycles Lendex 9 cycles with the Carfilzomib Lenalidomide and dexamethasone 18 cycles and Dara Tumumab Carfilzomib Lenalidomide and dexamethasone 18 cycles and the primary endpoint was to evaluate the minimal residual disease negativity rate after these 18 cycles. Of note, in order to identify the fit population we use the geriatric assessment in hematology score that evaluates different dimensions like the polypharmacy, gait speed, mood status, psychological status, comorbidities and so on. So with this scale we selected only fit patients. The primary endpoint of the study was met and Carfilzomib Lenalidomide and dexamethasone as well as Dara Tumumab Carfilzomib Lenalidomide and dexamethasone resulted in a higher minimal residual disease negativity rate in comparison with the control arm and the MRD negativity rate was around 58-60% in the two experimental arms. And during this congress what we have evaluated is the possibility of using a short consolidation with the Dara Lendex in those patients who didn't receive Dara Tumumab as part of the induction and when a patient received these four consolidation cycles with the Dara Lendex we had the possibility to see how the MRD negativity rate improved from 40-60, from 72-76. So this means that in the clinical practice if patients start with just a triplet KRD or Bortezomib Lenalidomide and dexamethasone, physicians can potentially complement this induction with a short consolidation based on Dara Lendex and the MRD negativity rate will increase. The median follow-up of this study is now approximately four years and when we evaluate on the intent to treat patient population the progression free survival we realized how Carfilzomib Lenalidomide and dexamethasone and Dara Tumumab Carfilzomib Lenalidomide and dexamethasone are superior to the control arm indicating that we have to move to the triplets incorporating Carfilzomib and maybe the best combination for fit patients will be based on the quadruplets as it has been previously demonstrated also in other phase three clinical studies like Cepheus and Inroth. So I will summarize saying that in the transplant in eligible population the use of geriatric scales will help us to individualize and to precise much more the treatment in order the patients to get the maximum benefit.
HealthTree • January 13, 2025