Dr Baljevic on Key Considerations for Treatment Selection in Newly Diagnosed Multiple Myeloma

Muhamed Baljevic, MD, FACP, hematologist and medical oncologist,associate professor of medicine, Division of Hematology Oncology; director, Plasma Cell Disorders Research of Vanderbilt-Ingram Cancer Center; director, Vanderbilt Amyloidosis Multidisciplinary Program, Vanderbilt-Ingram Cancer Center; co-chair, VICC Protocol Review and Monitoring System, discusses patient comorbidities and preferences to take into consideration when determining personalized treatment approaches in newly diagnosed multiple myeloma. Baljevic expanded on these topics in his presentation at the Vanderbilt Stem Cell Transplant and Cellular Therapy Symposium.

In the era of personalized medicine, understanding patient comorbidities and factors influencing therapy choice is paramount, Baljevic begins, emphasizing that considering patient preferences and their logistical capabilities for therapy delivery is crucial. The COVID-19 pandemic has significantly altered approaches to patient care, including therapeutic choices and administration methods. Although the primary goal of treatment is still to deliver effective therapeutics, individual perceptions of quality of life and treatment priorities can vary, he states.

Currently, quadruplet regimens are the standard of care (SOC) for the management of newly diagnosed multiple myeloma, Baljevic continues. The phase 2 GRIFFIN study (NCT02874742), which evaluated the addition of daratumumab (Darzalex) to the combination of lenalidomide (Revlimid), dexamethasone, and bortezomib (Velcade; D-RVd) plus autologous stem cell transplant (ASCT), has shown promising long-term follow-up results, he says. Specifically, the study reported a significantly better 4-year progression-free survival (PFS) with the quadruplet regimen compared with RVd alone, although PFS was not the primary end point of the GRIFFIN study, Baljevic states.

Despite the lack of difference in overall survival between these regimens, there was a notable improvement in the depth of responses over time, Baljevic reports. From the end of induction through post-transplant consolidation, and even to the final analysis, both the triplet and quadruplets demonstrated continued deepening and improving responses. However, the quadruplet regimen showed a greater ability to induce deep minimal residual disease (MRD) responses, Baljevic notes.

The evolving landscape of multiple myeloma treatment underscores the importance of personalized approaches that balance efficacy, patient preferences, and logistical considerations, Baljevic concludes.