Ixazomib, Lenalidomide, and Dexamethasone (IRD) Treatment with Cytogenetic Risk-Based Maintenance in Transplant-Eligible Myeloma: A Phase 2 Multicenter Study by the Nordic Myeloma Study Group

Anu Partanen, Anders Waage, Valdas Peceliunas, Fredrik Schjesvold, Pekka Anttila, Marjaana Säily, Katarina Uttervall, Mervi Putkonen, Kristina Carlson, Einar Haukas, Marja Sankelo, Damian Szatkowski, Markus Hansson, Anu Marttila, Ronald Svensson, Per Axelsson, Birgitta Lauri, Maija Mikkola, Conny Karlsson, Johanna AbelssonErik Ahlstrand, Anu Sikiö, Monika Klimkowska, Reda Matuzeviciene, Mona Hoysaeter Fenstad, Sorella Ilveskero, Tarja-Terttu Pelliniemi, Hareth Nahi, Raija Silvennoinen

Research output: Contribution to journalArticleScientificpeer-review

Abstract

Scarce data exist on double maintenance in transplant-eligible high-risk (HR) newly diagnosed multiple myeloma (NDMM) patients. This prospective phase 2 study enrolled 120 transplant-eligible NDMM patients. The treatment consisted of four cycles of ixazomib–lenalidomide–dexamethasone (IRD) induction plus autologous stem cell transplantation followed by IRD consolidation and cytogenetic risk-based maintenance therapy with lenalidomide + ixazomib (IR) for HR patients and lenalidomide (R) alone for NHR patients. The main endpoint of the study was undetectable minimal residual disease (MRD) with sensitivity of <10−5 by flow cytometry at any time, and other endpoints were progression-free survival (PFS) and overall survival (OS). We present the preplanned analysis after the last patient has been two years on maintenance. At any time during protocol treatment, 28% (34/120) had MRD < 10−5 at least once. At two years on maintenance, 66% of the patients in the HR group and 76% in the NHR group were progression-free (p = 0.395) and 36% (43/120) were CR or better, of which 42% (18/43) had undetectable flow MRD <10−5. Altogether 95% of the patients with sustained MRD <10−5, 82% of the patients who turned MRD-positive, and 61% of those with positive MRD had no disease progression at two years on maintenance (p < 0.001). To conclude, prolonged maintenance with all-oral ixazomib plus lenalidomide might improve PFS in HR patients.

Original languageEnglish
Article number1024
JournalCancers
Volume16
Issue number5
Number of pages15
ISSN2072-6694
DOIs
Publication statusPublished - Mar 2024
MoE publication typeA1 Journal article-refereed

Bibliographical note

Publisher Copyright:
© 2024 by the authors.

Fields of Science

  • autologous stem cell transplantation
  • ixazomib
  • maintenance
  • measurable residual disease
  • multiple myeloma
  • progression-free survival
  • 3122 Cancers

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