Affiliation:
1. Department of Stem Cell Transplantation and Cellular Therapy The University of Texas MD Anderson Cancer Center Houston Texas USA
2. Institute of Hematology, Davidoff Cancer Center Rabin Medical Center Petah‐Tikva Israel
3. Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
4. Department of Biostatistics The University of Texas MD Anderson Cancer Center Houston Texas USA
5. Department of Lymphoma and Myeloma The University of Texas MD Anderson Cancer Center Houston Texas USA
Abstract
AbstractThe optimal duration of lenalidomide (Len) maintenance for patients with multiple myeloma (MM) after autologous stem cell transplantation (autoHCT) is unknown. We conducted a retrospective single‐center analysis of adult MM patients that received upfront autoHCT between 2005 and 2021, followed by single‐agent Len maintenance. A total of 1167 patients were included with a median age of 61.4 (range 25.4–82.3) years, and high‐risk chromosomal abnormalities in 19%. Median duration of maintenance was 22.3 (range 0.03–139.6) months. After a median follow‐up of 47.9 (range 2.9–171.7) months, median PFS and OS for the entire cohort were 56.6 (95% CI 48.2–61.4) months and 111.3 (95% CI 101.7–121.5) months, respectively. In MVA, high‐risk cytogenetics was associated with a worse PFS (HR 1.91) and OS (HR 1.73) (p < .001 for both). Use of KRD induction and achievement of MRD‐negative ≥ VGPR before autoHCT were associated with an improved PFS (HR 0.53 and HR 0.57, respectively; p < .001 for both). Longer maintenance duration, even with a 5‐year cutoff, was associated with superior PFS and OS (HR 0.17 and 0.12, respectively; p < .001 for both). A total of 106 patients (9%) developed a second primary malignancy (SPM), mostly solid tumors (39%) and myeloid malignancies (30%). Longer maintenance duration was associated with a higher risk of SPM, reaching statistical significance after >2 years (odds ratio 2.25; p < .001). In conclusion, outcomes with Len maintenance were comparable to those reported in large clinical trials. Longer duration of maintenance, even beyond 5 years, was associated with improved survival.
Funder
Dr. Miriam and Sheldon G. Adelson Medical Research Foundation
Leukemia and Lymphoma Society
National Cancer Institute
Paula and Rodger Riney Foundation