Session: 654. Multiple Myeloma: Pharmacologic Therapies: Poster III
Hematology Disease Topics & Pathways:
Clinical trials, Research, Clinical Research
Study Design and Methods: SKylaRk was a phase II study of isa-KRd in 50 transplant-eligible (TE) NDMM patients (NCT04430894). All patients received 4 cycles of isa-KRd followed by stem cell collection with option of upfront versus deferred ASCT. Patients who had upfront ASCT received 2 additional cycles then maintenance. Patients who deferred ASCT received 4 additional cycles then maintenance. Each 28-day cycle consisted of isa 10 mg/kg iv weekly cycles 1-2, Q2 weeks cycles 3-6, then Q4 weeks; K (20 mg/m2 cycle 1, day 1 only) 56 mg/m2 iv days 1, 8, 15; len 25 mg po days 1-21; and dex 20 mg po days 1, 2, 8, 9, 15, and 16 (and days 22, 23 cycles 1-2).
For maintenance, patients with standard-risk received len 10 mg po days 1-21, and patients with HRCA (del 17p, gain 1q, t(4:14), t(14;16), or t(14;20)) continued on Isa 10 mg/kg iv day 1; K 56 mg/m2 iv days 1, 15; len 10 mg po days 1-21. Promising results of the primary analysis were previously reported (O’Donnell E et al., Lancet Haematol 2024). In this post-hoc analysis, we report the outcomes of patients who deferred ASCT and were evaluated based on cytogenetic risk.
Results: We enrolled TE 50 patients between August 2020 and February 2022; 4 patients did not have FISH information; 5 patients received high dose melphalan and auto SCT; 3 patients came off study before stem cell collection. We therefore focused on 41 patients with FISH information who did not undergo ASCT with median follow-up 35.9 months. Median age was 59 years (range 39-70) and 56% were male. Three-year progression free survival (PFS) overall (N=41) was 79.6% (95% CI, 67-94.5%). Three-year PFS by HRCA: no HRCA (N=20), 89.5% (76.7-100%); HRCA 1 (N=16), 82.5% (63.1-100%); HRCA 2 (N=5) not assessable due to insufficient follow up for this cohort, respectively. Median PFS was not reached (NR) for HRCA 0-1 and was shorter at 33 months (32.8-NR) for HRCA 2. For high-risk FISH defined by IMWG (del 17p, t(4;14), t(14;16)), three-year PFS for standard-risk (N=31) was 93.1% (84.3-100%) and for high-risk (N=10) not assessable due to insufficient follow-up for this cohort. Median PFS in months was NR for standard-risk and was 32.8 months (30.7- NR) for high-risk.
Conclusions: This is one of the first reports of a 4-drug regimen, isa-KRd, analyzed by cytogenetic risk in TE patients who have not undergone ASCT. While median follow up remains short, with isa-KRd, patients with 0-1 HRCAs who deferred ASCT demonstrated outcomes comparable to those seen in 4-drug combinations with upfront ASCT. However, while the number of patients is limited (N=5), the poorer outcomes for patients with 2 HRCAs who deferred ASCT suggest the need for further improvement, and for whom there may be more value for ASCT in this high-risk population as well as other additional innovative strategies, such as CAR-T and/or bispecific therapies.
Disclosures: O'Donnell: Grail: Consultancy; Natera: Membership on an entity's Board of Directors or advisory committees; Exact Sciences: Honoraria; Legend Pharmaceuticals: Membership on an entity's Board of Directors or advisory committees; BMS: Consultancy; Sanofi: Consultancy, Honoraria; Pfizer: Consultancy. Mo: AbbVie, Bristol Myers Squibb, GSK, Janssen, Karyopharm, Sanofi, and Takeda: Membership on an entity's Board of Directors or advisory committees; AbbVie, Janssen, Karyopharm, and Sanofi: Consultancy. Nadeem: Pfizer: Honoraria; BMS: Membership on an entity's Board of Directors or advisory committees, Research Funding; Takeda: Membership on an entity's Board of Directors or advisory committees, Research Funding; GPCR Therapeutics: Membership on an entity's Board of Directors or advisory committees; Janssen: Membership on an entity's Board of Directors or advisory committees, Research Funding; JNJ: Research Funding; Sanofi: Membership on an entity's Board of Directors or advisory committees. Rosenblatt: Janssen Pharmaceuticals: Membership on an entity's Board of Directors or advisory committees; Karyopham therapeutics: Other: DSMB; Parexel/Calyx: Consultancy, Other: blinded adjudicator for clinical trial data; Clario (BioClinica): Consultancy, Other: blinded adjudicator for clinical trial data; Sanofi: Research Funding; Bristol myers squibb: Research Funding; Attivare therapeutics: Consultancy; KITE: Membership on an entity's Board of Directors or advisory committees; USPTO: Patents & Royalties: US patent no. 11, 026,921, . Munshi: Oncopep: Current holder of stock options in a privately-held company; AbbVie, Adaptive Bio, Amgen, Bristol Myers Squibb, Celgene, GlaxoSmithKline, Janssen, Karyopharm, Legend Bio, Novartis, Oncopep, Pfizer, Recordati, Sebia, Takeda: Consultancy. Midha: Janssen: Consultancy; Pfizer: Consultancy. Cirstea: Sanofi: Consultancy. Richardson: Oncopeptides: Research Funding; Celgene/Bristol Myers Squibb, GSK, Karyopharm Therapeutics, Oncopeptides, Regeneron, Sanofi: Consultancy. Raje: Caribou Biosciences Inc: Membership on an entity's Board of Directors or advisory committees; Takeda Pharmaceuticals USA Inc: Membership on an entity's Board of Directors or advisory committees; Onyx Pharmaceuticals: Membership on an entity's Board of Directors or advisory committees; Novartis: Membership on an entity's Board of Directors or advisory committees; bluebird bio: Membership on an entity's Board of Directors or advisory committees, Research Funding; Janssen Biotech Inc: Membership on an entity's Board of Directors or advisory committees; Bristol-Myers Squibb: Membership on an entity's Board of Directors or advisory committees; Merck: Membership on an entity's Board of Directors or advisory committees; Celgene Corporation: Membership on an entity's Board of Directors or advisory committees; Immuneel Therapeutics: Membership on an entity's Board of Directors or advisory committees; Amgen Inc: Other: Steering Committee; Roche Laboratories Inc: Other: Steering Committee. Yee: Takeda: Consultancy; Sebia: Consultancy; Sanofi: Consultancy; Regeneron: Consultancy; Prothena: Consultancy; Pfizer: Consultancy; Karyopharm: Consultancy; J&J: Consultancy; GSK: Consultancy; BMS: Consultancy; Amgen: Consultancy; Adaptive Biotechnologies: Consultancy; AbbVie: Consultancy.
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