ASH 2019: An All-Oral Approach for Smoldering Myeloma Patients

Smoldering myeloma was a hot topic at the recent American Society of Hematology meeting, Researchers are especially intent on discussing how to treat high risk smoldering myeloma - or patients who are most likely to progress to active myeloma within a 24 month period. A multitude of approaches are being used from single drugs to full blown myeloma therapy. 

Dr. Irene Ghobrial of the Dana Farber Cancer Institute shared study results from a smoldering myeloma trial using a triple combination of a proteasome inhibitor, immunomodulator and steroid. This is a common combination used in typical myeloma care.  When researchers began clinical trials for smoldering myeloma patients, they started with a single drug - typically lenalidomide. Now specialists wonder if that's enough, or if a single drug allows the myeloma to escape and grow.  

The goal of the study was to strike a balance between care that would prevent active myeloma while at the same time reducing side effects for patients with this precursor condition. 

The study is enrolling 62 patients. The 53 patients participating in the study to date received the triplet combination of ixazomib/lenalidomide/dex for 9 cycles of therapy and then ixazomib/lenalidomide maintenance for another 15 cycles (about 2 years of total treatment). 

The median follow up was 14.4 months. Over half (54%) of the patients had high risk genetic features. Over half (53%) of the patients also had clear high risk smoldering myeloma. 

As of the abstract date: 

• Patients had an overall response rate of 100% 
• 14 patients had stringent complete responses (70% of these had MRD negative disease)
• 9 patients had very good partial responses
• 18 patients had partial responses
• 4 patients had minimal responses
• None of the patients had progressed to active myeloma
• None of the patients developed end organ damage

Dr. Ghobrial noted that this combination may provide convenient, effective therapy with minimal toxicity for this patient group.