Elotuzumab/Lenalidomide Maintenance Deepens Responses After Transplant in Myeloma

Wayne Kuznar
Published: Wednesday, Dec 13, 2017

“This has improved to 91% based on best response estimates on study, including 51% who have achieved CR or sCR,” Thomas said. Investigators observed no difference in PFS according to cytogenetic risk. Six patients progressed, 3 with high-risk features and 3 with standard-risk features. One patient with high-risk features died while in VGPR.

Three patients have died, 2 from progressive disease while on salvage therapy and a third from acute encephalopathy with refractory status epilepticus while in VGPR.

Seventy-one percent of patients had any-grade anemia, 69% had neutropenia, and 68% had thrombocytopenia. Grade ≥3 anemia, neutropenia, and thrombocytopenia occurred in 6%, 31%, and 7% of patients, respectively. The rate of grade ≥3 febrile neutropenia was 4%. Fatigue (76%) was the most common non-hematologic adverse event (AE), followed by myalgias (71%), diarrhea (69%), respiratory infections (57%), nausea/vomiting (57%), and dizziness (56%).

Forty-four percent of patients required dose reductions of lenalidomide. Thomas said most patients are currently dosed at 10 mg on days 1 through 21 of the 28-day cycle due to intolerability.

Four patients developed secondary primary malignancies—intraepidermal adenocarcinoma of the neck, mucinous appendiceal neoplasm, renal cell carcinoma, and therapy-related myelodysplastic syndrome. The first 3 were managed with curative resection and the patinets remain free of disease related to their second primary malignancy. Two patients remain on study.

References

  1. Thomas SK, Shah JJ, Weber DM, et al. Preliminary results of a phase II study of lenalidomide-elotuzumab as maintenance therapy post-autologous stem cell transplant in patients with multiple myeloma. Presented at: Presented at: American Society of Hematology 59th Annual meeting; December 9-12, 2017; Atlanta, GA. Abstract 840.
  2. McCarthy PL, Ozwar K, Hofmeister CC, et al. Lenalidomide after stem-cell transplantation for multiple myeloma. N Engl J Med. 2012;366:1770-81.
  3. Attal M, Lauwers-Cances V, MaritG, et al. Lenalidomide maintenance after stem-cell transplantation for multiple myeloma. N Engl J Med. 2012;366:1782-91.
  4. Dimopoulos MA, Lonial S, White D, et al. Elotuzumab plus lenalidomide/dexamethasone for relapsed or refractory multiple myeloma: ELOQUENT-2 follow-up and post-hoc analyses on progression-free survival and tumour growth. Br J Haematol. 2017;178:896-905.



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