Thomas G. Martin, MD
Autologous stem cell transplantation (ASCT) continues to have an imperative role in the multiple myeloma paradigm, as most patients with the disease are able to tolerate it and it is a go-to strategy for physicians, explained Thomas G. Martin, MD.
State of the Science Summit™ on Hematologic Malignancies, Martin, associate director of the Myeloma Program at the University of California, San Francisco, discussed the clinical utility of ASCT and the rapidly evolving treatment paradigm of myeloma.
OncLive: Please provide an overview of your presentation.
: There are some limitations to ASCT. Patients older than age 75 are rarely transplant candidates. I would say almost all patients younger than 70 are eligible candidates. Most of the patients, if they're ineligible, it's because they have ongoing pulmonary comorbidities or cardiac issues.
The future is bright in terms of all the agents we have. In the future, because we're seeing such great activity in patients who are receiving CAR T-cell therapy, it's very possible this type of treatment early on will limit the use of transplant. We will need a randomized trial looking at this.
In terms of induction, is lenalidomide, bortezomib, and dexamethasone (RVd) still the standard or can physicians use carfilzomib (Kyprolis), lenalidomide, and dexamethasone (KRd)?
We have had several trials that have combined a proteasome inhibitor plus an immunomodulatory agent versus a proteasome inhibitor plus an alkylating agent. We have done that with bortezomib and carfilzomib. In all these randomized trials, the arms that had a proteasome inhibitor plus an immunotherapy did better. Frontline therapy should be a proteasome inhibitor, immunotherapy, and dexamethasone. This is in a transplant-ineligible population.
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