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Minimal residual disease negativity and lenalidomide maintenance therapy are associated with superior survival outcomes in multiple myeloma

Bone Marrow Transplantation volume 55, pages 1137–1146 (2020)Cite this article

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Abstract

Modern combinations of therapies for multiple myeloma have led to improvement in survival outcomes with near 100% overall response rate and 25% complete response rates, particularly with autologous hematopoietic cell transplant (AHCT). Minimal residual disease (MRD) assessment with multiparameter flow cytometry is a valid prognostic biomarker for progression-free survival (PFS) and overall survival (OS). However, few data exist regarding whether MRD positivity or negativity will meaningfully influence treatment decisions. We evaluated 433 patients who received induction therapy, followed by AHCT. Participants had MRD assessment by multiparameter flow cytometry before and at days +100 and +365 following AHCT. They also received either lenalidomide, bortezomib, or no maintenance therapy following AHCT. Maintenance treatment with lenalidomide improved MRD negativity at day +365 compared to bortezomib (92.9% vs 41.6%, p = 0.01), or no maintenance therapy (92.9% vs 24.4%, p = 0.012). The median PFS for patients who were MRD negative at day + 365 was 42 vs 17.5 months (p < 0.001) and median OS was 80.6 vs 59 months (p = 0.02). Maintenance therapy following AHCT for multiple myeloma improves the depth of response as assessed by MRD.

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Fig. 1: Consort diagram including three cohorts.
Fig. 2
Fig. 3: Pre-transplant variables and impact on survival outcomes post-AHCT.
Fig. 4

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Acknowledgements

The authors would like to acknowledge all of the staff at Vanderbilt University Medical Center and Vanderbilt Ingram Cancer Center for their work in caring for patients with multiple myeloma. Statistical analysis performed by Ragisha Gopalakrishnan and Evonne McArthur.

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Author notes

  1. These authors contributed equally: Dilan A. Patel, Ragisha Gopalakrishnan

Authors and Affiliations

  1. Department of Medicine, Division of Hematology/Oncology, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, USA

    Dilan A. Patel, Ragisha Gopalakrishnan, Brian G. Engelhardt, Salyka Sengsayadeth, Katie A. Culos, Michael Byrne, Stacey Goodman, Bipin N. Savani, Wichai Chinratanalab, Madan Jagasia, Robert F. Cornell & Adetola A. Kassim

  2. Department of Medicine, Division of Hematology/Oncology, Hematology and Stem Cell Transplant, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, USA

    Brian G. Engelhardt, Salyka Sengsayadeth, Michael Byrne, Stacey Goodman, Bipin N. Savani, Wichai Chinratanalab, Madan Jagasia, Robert F. Cornell & Adetola A. Kassim

  3. Vanderbilt University School of Medicine, Nashville, TN, USA

    Evonne McArthur

  4. Department of Pharmaceutical Services, Vanderbilt University Medical Center, Nashville, TN, USA

    Katie A. Culos

  5. Department of Pathology, Microbiology, Immunology, Vanderbilt University Medical Center, Nashville, TN, USA

    Claudio A. Mosse

  6. Pathology and Laboratory Medicine, VA Tennessee Valley Healthcare System, Nashville, TN, USA

    Claudio A. Mosse

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Correspondence to Adetola A. Kassim.

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Patel, D.A., Gopalakrishnan, R., Engelhardt, B.G. et al. Minimal residual disease negativity and lenalidomide maintenance therapy are associated with superior survival outcomes in multiple myeloma. Bone Marrow Transplant 55, 1137–1146 (2020). https://doi.org/10.1038/s41409-020-0791-y

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