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4971 Real-World Mobilization, Harvest, and Transplant Outcomes in Newly Diagnosed Multiple Myeloma Patients Receiving D-VTd: A UK Centre Experience

Program: Oral and Poster Abstracts
Session: 731. Autologous Transplantation: Clinical and Epidemiological: Poster III
Monday, December 11, 2023, 6:00 PM-8:00 PM

Christianne Bourlon, MD, MSc1, Katharine Elizabeth Bailey1, Reuben Benjamin1*, Kirsty Cuthill1*, Arief Gunawan1*, Majid Kazmi2*, Pramila Krishnamurthy3*, Victoria Potter3*, Robin Sanderson4, Michelle Kenyon1*, Mili Shah3*, Matthew Streetly2*, Fabio Serpenti, MD5*, Stella J. Bowcock6*, Lalita Banerjee7*, John Robert Jones, MD8*, Sabia Rashid9*, Ana Isabel Duran Maestre9*, Satyajit Sahu9*, Sudarshan Gurung10*, Lianwea Chia11*, Haili Cui1*, Alison Pratt1*, Maheen Ahsan1* and Stella Bouziana, MD, PhD1*

1King´s College Hospital, King’s College Hospital NHS Foundation Trust, London, United Kingdom
2Guy´s and St Thomas´NHS Foundation Trust, London, United Kingdom
3Department of Haematological Medicine, King's College Hospital NHS, London, United Kingdom
4Department of Haematology, King’s College Hospital NHS Foundation Trust, London, United Kingdom
5King’s College Hospital NHS Foundation Trust, London, United Kingdom
6Princess Royal University Hospital, King’s College Hospital NHS Foundation Trust,, London, United Kingdom
7Maidstone and Tunbridge Wells NHS Trust, Kent, United Kingdom
8East Sussex Healthcare NHS Trust, Kent, GBR
9Lewisham and Greenwich NHS Trust, London, United Kingdom
10Medway NHS Trust, London, ENG, GBR
11Dartford and Gravesham NHS Trust, Kent, United Kingdom


In newly diagnosed multiple myeloma (NDMM) patients eligible for autologous stem cell transplantation (ASCT), daratumumab plus, bortezomib, thalidomide, and dexamethasone (D-VTd) followed by high-dose melphalan with ASCT, is considered standard of care in Europe. The CASSIOPEIA trial reported a lower stem cell (SC) yield and higher plerixafor (PLX) use, but no impact over ASCT feasibility and safety for the D-VTd group. However, real-world data from clinical experience after its approval is scarce.

In the United Kingdom, the National Institute for Health and Care Excellence approved D-VTd as frontline treatment in November 2021. Our aim was to describe the real-world experience regarding mobilization, harvest, and ASCT outcomes in NDMM patients receiving D-VTd.


We included all consecutive NDMM patients referred from 10 haematology centres to our institution and subsequently to apheresis, from June 2022 to May 2023. Patients received D-VTd as induction and had achieved at least partial response at time of referral. Patients underwent SC mobilisation with cyclophosphamide 1.5g/m2 D+1, GCS-F 5µg/kg D+5 to D+10, and apheresis D+11 and D+12. Additional VTd cycles were given when length of waiting for apheresis was more than 6 weeks. Pre-emptive PLX was given for pre-apheresis CD34+count between 5-15cells/µL. After a successful harvest (≥2.0x106 CD34+cells/kg) ASCT was scheduled in 4-6weeks.


A total of 95 patients were included. The median age was 63 years (range 34-74), 71.6% were male, 16.8% were ISS-III, 9.2% were R-ISS-III, and 28.9% had high-risk cytogenetics. Regarding induction treatment patients received 4 cycles of D-VTD; additionally 11 (11.6%) received radiotherapy, and 36 (37.9%) additional VTD pre-apheresis,th a median of 2 (range 1-4). MM response pre-apheresis was ≥VGPR in 80%.

The median time from the start of D-VTd to apheresis was 6 months (range 4-10). A total of 87 patients underwent apheresis; 21 (22.1%) received pre-emptive PLX and 71 (81.6%) underwent two apheresis procedures. The mean pre-apheresis and total dose CD34+cells were 29.2/µL (range 0.4-220.7) and 4.5x106/kg (range 1.2-12.6), respectively. From the 14 patients that failed to collect ≥2.0x106cell/kg on first attempt, 8 underwent a second attempt. Overall harvest success rate was 92.6% (n = 88) (Figure 1). Regarding the additional VTd versus non-VTd groups, mean total CD34+cell dose was 5.1x106/kg (range 1.3-10.7) versus 4.8x106/kg (range 1.2-12.6) (p = 0.61) and PLX was used in 25% versus20.3% (p = 0.28).

After a median of 7 weeks (range 4-32), 68 patients (77.3%) proceeded to ASCT, 11 (12.5%) are awaiting, and 9 (10.2%) were cancelled. A 54.4% (n = 37) of patients experienced a delay for ASCT, 7 due to second harvest attempt. Mean CD34+cells infused was 3.7x106/kg (range 2.0-6.7). All patients achieved neutrophil and platelet engraftments after a median of 13 days (range 9-17) and 19 days (range 13-29), respectively. One patient died after engraftment, day +49, due to pneumonia. MM response at 100-days after ASCT was ≥VGPR in 97.1% and MRD-neg in 85.2% of the evaluated patients (Table 1).


Based on our results, we confirm that compared to published data the addition of daratumumab to VTd in NDMM patients, results in a lower SC yield and higher pre-emptive PLX administration. As expected, when reflecting the real-world practice timely interventions are difficult to maintain leading to delays on harvesting and ACST procedures. Herein we report the implementation of a “bridging” strategy with additional VTd cycles between D-VTd induction and apheresis, this did not influence our harvest outcomes. Although longer follow-up is desirable, our results regarding harvest success (92.6%) and ASCT outcomes, including engraftment and MM response at 100-days, are comparable to those reported by the CASSIOPEIA trial.

Disclosures: Sanderson: Novartis: Honoraria, Speakers Bureau; Gilead: Honoraria, Speakers Bureau.

*signifies non-member of ASH