Multiple Myeloma Update – A Key Finding from ASCO 2010

During July and August 2009, a case scenario involving first-line therapy for a “fit” patient with a new diagnosis of MM was presented to AHOMD consultants. Relevant history and physical, lab, imaging, and hematopathology data were provided. After receiving the consultant’s therapy of choice, the status of the patient’s disease was assessed, and level of response (complete response [CR], very good partial response [VGPR], partial response [PR]) to induction therapy was varied in sequential research queries to assess the impact of response status to initial therapy on plans for immediate ASCT. 

A summary of the recommendations by the magnitude of response after 4 cycles of induction therapy are shown below:

These data demonstrate that in a “fit” patient with a new diagnosis of MM who was considered a transplant candidate prior to starting therapy, follow-through with transplant depends on the magnitude of the induction response achieved.

• In the setting of CR after 4 cycles, 66% of AHOMD plan immediate ASCT, while 25% plan 2 added cycles of induction followed by observation or maintenance CT
  
• For the patients with VGPR after 4 induction cycles, plans for immediate ASCT fall to 51%, while 30% would plan 2 additional induction cycles and then reconsider ASCT
  
• When the response after 4 cycles has been a PR, a minority of AHOMD (41%) would recommend immediate ASCT consolidation, while plans for 2 additional induction cycles and then reconsideration of ASCT rises to 44%

A “magnitude of response-adapted paradigm” for total induction therapy, including or excluding ASCT consolidation, is operative in patients with a new diagnosis of MM.

1. Joanne Willey, RN, Kristine E. Lemke, MBA, Michael E. Williams, MD, Mark R Green, MD, Sagar Lonial, MD. Does the magnitude of response to initial induction therapy impact plans for immediate autologous stem cell transplant consolidation in the transplant-eligible patient with a new diagnosis of multiple myeloma? 2010 ASCO Annual Meeting. Abst # 8146.