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Lenalidomide-based triplet regimens in first relapsed multiple myeloma patients: real-world evidence from a propensity score matched analysis

Lenalidomide and dexamethasone (Rd)-based triplets, in particular carfilzomib-Rd (KRd) and daratumumab-Rd (DaraRd), represent a standard of care in lenalidomide-sensitive multiple myeloma (MM) patients in first relapse. Meta-analysis of randomized clinical trials (RCT), suggested better outcome with...

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Autores principales: Mangiacavalli, Silvia, Cartia, Claudio Salvatore, Galli, Monica, Pezzatti, Sara, Belotti, Angelo, Fazio, Francesca, Mina, Roberto, Marcatti, Magda, Cafro, Anna, Zambello, Renato, Paris, Laura, Barilà, Gregorio, Olivares, Cecilia, Pompa, Alessandra, Mazza, Rita, Farina, Francesca, Soldarini, Martina, Benvenuti, Pietro, Pagani, Giuseppina, Palumbo, Michele, Masoni, Valeria, Ferretti, Virginia Valeria, Klersy, Catherine, Arcaini1, Luca, Petrucci, Maria Teresa
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Fondazione Ferrata Storti 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9973473/
https://www.ncbi.nlm.nih.gov/pubmed/36200419
http://dx.doi.org/10.3324/haematol.2022.281342
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author Mangiacavalli, Silvia
Cartia, Claudio Salvatore
Galli, Monica
Pezzatti, Sara
Belotti, Angelo
Fazio, Francesca
Mina, Roberto
Marcatti, Magda
Cafro, Anna
Zambello, Renato
Paris, Laura
Barilà, Gregorio
Olivares, Cecilia
Pompa, Alessandra
Mazza, Rita
Farina, Francesca
Soldarini, Martina
Benvenuti, Pietro
Pagani, Giuseppina
Palumbo, Michele
Masoni, Valeria
Ferretti, Virginia Valeria
Klersy, Catherine
Arcaini1, Luca
Petrucci, Maria Teresa
author_facet Mangiacavalli, Silvia
Cartia, Claudio Salvatore
Galli, Monica
Pezzatti, Sara
Belotti, Angelo
Fazio, Francesca
Mina, Roberto
Marcatti, Magda
Cafro, Anna
Zambello, Renato
Paris, Laura
Barilà, Gregorio
Olivares, Cecilia
Pompa, Alessandra
Mazza, Rita
Farina, Francesca
Soldarini, Martina
Benvenuti, Pietro
Pagani, Giuseppina
Palumbo, Michele
Masoni, Valeria
Ferretti, Virginia Valeria
Klersy, Catherine
Arcaini1, Luca
Petrucci, Maria Teresa
author_sort Mangiacavalli, Silvia
collection PubMed
description Lenalidomide and dexamethasone (Rd)-based triplets, in particular carfilzomib-Rd (KRd) and daratumumab-Rd (DaraRd), represent a standard of care in lenalidomide-sensitive multiple myeloma (MM) patients in first relapse. Meta-analysis of randomized clinical trials (RCT), suggested better outcome with DaraRd. Trying to address this issue in clinical practice, we collected data of 430 consecutive MM patients addressed to Rd-based triplets in first relapse between January 2017 and March 2021. Overall, the most common used regimen was DaraRd, chosen in almost half of the cases (54.4%), followed by KRd (34.6%). Different triplets were used much less commonly. In an attempt to limit the imbalance of a retrospective analysis, we conducted a propensity score matching (PSM) comparison between DaraRd and KRd. After PSM, efficacy of DaraRd versus KRd was similar in terms of overall-response rate (ORR) (OR: 0.9, P=0.685) as well as of very good partial response (VGPR) or better (OR: 0.9, P=0.582). The median progression-free survival (PFS) was significantly longer for DaraRd (29.8 vs. 22.5 months; P=0.028). DaraRd was tolerated better, registering a lower rate of grade 3-4 non-hematological toxicity (OR: 0.4, P<0.001). With the limitations of any retrospective analysis, our real-life PSM comparison between DaraRd and KRd, in first-relapse MM patients, showed better tolerability and prolonged PFS of DaraRd, although with some gaps of performance, in particular of DaraRd, with respect to RCT. Carfilzomib-containing regimens, like KRd, still remain a valid second-line option in the emerging scenario of first-line daratumumab-based therapy.
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spelling pubmed-99734732023-03-01 Lenalidomide-based triplet regimens in first relapsed multiple myeloma patients: real-world evidence from a propensity score matched analysis Mangiacavalli, Silvia Cartia, Claudio Salvatore Galli, Monica Pezzatti, Sara Belotti, Angelo Fazio, Francesca Mina, Roberto Marcatti, Magda Cafro, Anna Zambello, Renato Paris, Laura Barilà, Gregorio Olivares, Cecilia Pompa, Alessandra Mazza, Rita Farina, Francesca Soldarini, Martina Benvenuti, Pietro Pagani, Giuseppina Palumbo, Michele Masoni, Valeria Ferretti, Virginia Valeria Klersy, Catherine Arcaini1, Luca Petrucci, Maria Teresa Haematologica Article - Plasma Cell Disorders Lenalidomide and dexamethasone (Rd)-based triplets, in particular carfilzomib-Rd (KRd) and daratumumab-Rd (DaraRd), represent a standard of care in lenalidomide-sensitive multiple myeloma (MM) patients in first relapse. Meta-analysis of randomized clinical trials (RCT), suggested better outcome with DaraRd. Trying to address this issue in clinical practice, we collected data of 430 consecutive MM patients addressed to Rd-based triplets in first relapse between January 2017 and March 2021. Overall, the most common used regimen was DaraRd, chosen in almost half of the cases (54.4%), followed by KRd (34.6%). Different triplets were used much less commonly. In an attempt to limit the imbalance of a retrospective analysis, we conducted a propensity score matching (PSM) comparison between DaraRd and KRd. After PSM, efficacy of DaraRd versus KRd was similar in terms of overall-response rate (ORR) (OR: 0.9, P=0.685) as well as of very good partial response (VGPR) or better (OR: 0.9, P=0.582). The median progression-free survival (PFS) was significantly longer for DaraRd (29.8 vs. 22.5 months; P=0.028). DaraRd was tolerated better, registering a lower rate of grade 3-4 non-hematological toxicity (OR: 0.4, P<0.001). With the limitations of any retrospective analysis, our real-life PSM comparison between DaraRd and KRd, in first-relapse MM patients, showed better tolerability and prolonged PFS of DaraRd, although with some gaps of performance, in particular of DaraRd, with respect to RCT. Carfilzomib-containing regimens, like KRd, still remain a valid second-line option in the emerging scenario of first-line daratumumab-based therapy. Fondazione Ferrata Storti 2022-10-06 /pmc/articles/PMC9973473/ /pubmed/36200419 http://dx.doi.org/10.3324/haematol.2022.281342 Text en Copyright© 2023 Ferrata Storti Foundation https://creativecommons.org/licenses/by-nc/4.0/This article is distributed under the terms of the Creative Commons Attribution Noncommercial License (by-nc 4.0) which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author(s) and source are credited.
spellingShingle Article - Plasma Cell Disorders
Mangiacavalli, Silvia
Cartia, Claudio Salvatore
Galli, Monica
Pezzatti, Sara
Belotti, Angelo
Fazio, Francesca
Mina, Roberto
Marcatti, Magda
Cafro, Anna
Zambello, Renato
Paris, Laura
Barilà, Gregorio
Olivares, Cecilia
Pompa, Alessandra
Mazza, Rita
Farina, Francesca
Soldarini, Martina
Benvenuti, Pietro
Pagani, Giuseppina
Palumbo, Michele
Masoni, Valeria
Ferretti, Virginia Valeria
Klersy, Catherine
Arcaini1, Luca
Petrucci, Maria Teresa
Lenalidomide-based triplet regimens in first relapsed multiple myeloma patients: real-world evidence from a propensity score matched analysis
title Lenalidomide-based triplet regimens in first relapsed multiple myeloma patients: real-world evidence from a propensity score matched analysis
title_full Lenalidomide-based triplet regimens in first relapsed multiple myeloma patients: real-world evidence from a propensity score matched analysis
title_fullStr Lenalidomide-based triplet regimens in first relapsed multiple myeloma patients: real-world evidence from a propensity score matched analysis
title_full_unstemmed Lenalidomide-based triplet regimens in first relapsed multiple myeloma patients: real-world evidence from a propensity score matched analysis
title_short Lenalidomide-based triplet regimens in first relapsed multiple myeloma patients: real-world evidence from a propensity score matched analysis
title_sort lenalidomide-based triplet regimens in first relapsed multiple myeloma patients: real-world evidence from a propensity score matched analysis
topic Article - Plasma Cell Disorders
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9973473/
https://www.ncbi.nlm.nih.gov/pubmed/36200419
http://dx.doi.org/10.3324/haematol.2022.281342
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