Continued Role for Transplantation in NDMM


Before closing out his discussion on newly diagnosed multiple myeloma, Ajay K. Nooka, MD, MPH, FACP, emphasizes the continued role of transplantation in this setting.


Ajay K. Nooka, MD, MPH, FACP: A transplant is a method to deepen the response. So here we are using transplant as an additional maneuver to deepen the response, and every clinical trial that has ever been done so far has shown the benefit of a transplant in providing the depth of the responses measured by the MRD [minimal residual disease] negativity, as well as the PFS [progression-free survival] benefit.

…[In] the IFM 2009 trial, among these patients who received the 3 drugs of induction treatment with RVd [lenalidomide (Revlimid), bortezomib (Velcade), and dexamethasone], went for a transplant, and [had] the fixed duration of maintenance after consolidation with RVd versus patients who received RVd for 3 cycles followed by 5 cycles of consolidation followed by maintenance.

Among these 2 arms, which was questioning the timing of the transplant, you were able to see the achievement of MRD negativity among these patients, so to be favoring the transplant arm.

If you look at the benefit of the quality of MRD negativity among these patients, even though the patients who achieved [an] MRD negativity, who did not go for a transplant, had lesser PFS compared to those patients who achieved an MRD negativity that went for a transplant.

Suggesting that the quality of responses among those achieving MRD negativity matters, and this can only be amplified by using a transplant. We can have the most effective induction regimens, but transplant is there to deepen those responses, which has clearly shown to translate into [a] PFS benefit.

And right now, with the shorter follow-up, we may not be able to comment on the overall survival benefits, but what we are seeing is a surrogate to these overall survival benefits with the short endpoints, for the MRD negativity as far as the PFS benefits of favoring the transplant arms across all the studies.

Transcript edited for clarity.

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