Update from ASCO 2022 – Myeloma

I'm Hans Lee, coming to you from the ASCO 2022 annual meeting in Chicago and I'll be providing my perspective on the late breaking abstract plenary that was just presented of the phase 3 DETERMINATION study.

Now the phase 3 DETERMINATION study really sought to answer a key question of what is the role of upfront high dose melphalan and autologous stem cell rescue in newly diagnosed multiple myeloma patients that receive optimal triplet based induction therapy with bortezomib, lenalidomide and dexamethasone followed by lenalidomide maintenance therapy until disease progression.

The key results of this study demonstrate that there is a significant improvement of progression free survival of approximately 21 months in patients who underwent upfront high dose chemotherapy and autologous stem cell rescue compared to those patients who didn't.

However, at the time that the study is being reported, there was no difference in overall survival between the patients who underwent upfront versus delayed high dose chemotherapy and autologous stem cell rescue.

From my perspective, the data from the DETERMINATION study impact my clinical practice in two main ways.

First, it confirms that upfront high dose chemotherapy and autologous stem cell rescue remains the standard of care in newly diagnosed multiple myeloma patients that receive optimal induction therapy with bortezomib, lenalidomide and dexamethasone.

Secondly, it confirms the role of maintenance lenalidomide after induction therapy until disease progression.

However, without an overall survival benefit seen between those patients who underwent upfront transplant versus those who didn't, it's still important to have a discussion with patients regarding the benefits and risks of autologous stem cell transplant and future analysis from the DETERMINATION study and also the future prospective studies will be very informative to define the right groups of patients that will benefit optimally from upfront stem cell transplant.

Thank you.

Read the publication online in the NEJM