Professor Chen Wenming: Progress in the treatment of multiple myeloma

Professor Chen Wenming from Beijing Chaoyang Hospital Affiliated to Capital Medical University shared a special report on "Multiple Myeloma Treatment Progress-2020 ASH Highlights" at the 2021 Leukemia·Lymphoma Summit Forum, summarizing a large number of valuable studies from the ASH conference result.

The editor is organized as follows for readers.

The CAR-T treatment UNIVERSAL study included patients with relapsed and refractory multiple myeloma (RRMM), aiming to observe the safety and tolerability of allogeneic BCMA CAR-T ALLO-715 combined with ALLO-647 (targeted CD52) treatment Sex.

The results of the phase I study showed that no obvious GVHD occurred, and the main adverse reactions were cytokine release syndrome (CRS), and the main adverse reactions were grade 1-2.

In addition, the study also observed that the dose of CAR-T treatment is correlated with the efficacy.

The CARTITUDE-1 study evaluated the safety and efficacy of BCMA CAR-T cell therapy in RRMM patients, and 2020 ASH reported its phase I/II data.

Adverse reactions are mainly concentrated in hematological toxicity.
The incidence of grade 3-4 thrombocytopenia, neutropenia, and anemia is relatively high, and the recovery time is relatively slow.

The 1-year progression-free survival (PFS) rate was 76.
6%, and the 1-year overall survival (OS) rate was 88.
5%.

The antibody-drug conjugate DREAMM-2 study is a randomized, open, phase II clinical study, which aims to evaluate the performance of the antibody-drug conjugate (ADC) Belantamab Mafodotin in the treatment of RRMM.

The results showed that the overall response rate (ORR) of Belantamab Mafodotin treatment for 3-6 line treatment patients was 34%, and the ORR for more than 7-line treatment was 30%.

The main adverse reaction is corneal injury, and hematological toxicity is relatively high.

The DREAMM-6 study explored the efficacy of Belantamab Mafodotin combined with bortezomib/dexamethasone on RRMM patients who have received ≥1 line therapy.
The results found that Belantamab Mafodotin combined with bortezomib/dexamethasone may have synergistic therapeutic effects, but adverse effects Corneal damage is also the main cause.

The bispecific antibody AMG 701 is a bispecific antibody targeting BCMA/CD3.
The 2020 ASH meeting reported its phase I clinical data on its efficacy in the treatment of relapsed and refractory multiple myeloma.

ORR reached 83%.

The main adverse reaction is CRS, and the overall safety is controllable.

The total effectiveness of BCMA and CD3 bispecific antibody teclistamab in the treatment of RRMM is 64%.
The occurrence of adverse reactions is very similar to that of CAR-T treatment.
Hematological adverse reactions are also concentrated in neutropenia, thrombocytopenia and anemia.
In terms of safety and tolerance, it is acceptable.

The targeted drug APOLLO study compared Daratumumab combined with pomalidomide/dexamethasone in the treatment of RRMM with pomalidomide and dexamethasone monotherapy.

The results showed that the PFS of Daratumumab combined with pomalidomide/dexamethasone was 12.
4 months, while the PFS of pomalidomide/dexamethasone treatment was 6.
9 months, and the total effectiveness was close to 70%.

The main adverse reaction is hematological toxicity.

The MAIA study compared daratumumab (D) combined with lenalidomide/dexamethasone (Rd) (D-Rd regimen) and lenalidomide and dexamethasone regimen (Rd regimen) in the treatment of newly diagnosed multiple myeloma (NDMM) The patient’s performance was updated at the 2020 ASH meeting with his 4-year follow-up data.

The PFS rate of the D-Rd regimen is 60%, and the PFS rate of the Rd regimen is only 38%.
The latest results of the MAIA study suggest that the D-Rd regimen can have long-term benefits in the treatment of MM.

The latest follow-up results of the GRIFFIN study showed that the combined treatment of daratumumab+bortezomib/lenalidomide/dexamethasone (VRd) (D-VRd regimen) was significantly better than the VRd regimen in the depth of relief.
There was no statistically significant difference between the two in terms of PFS and OS.
difference.

The duration of remission (DOR) of the D-VRd program was significantly longer than that of the VRd program.

Adverse reactions are mainly concentrated in hematological toxicity.

The TOURMALINE-MM2 study compared the differences between the Ixazomib-Rd regimen and the placebo-Rd regimen.

The depth of remission of the Ixazomib-Rd regimen was significantly better than that of the placebo-Rd regimen, and the DOR of the Ixazomib-Rd regimen was also significantly better than that of the placebo-Rd regimen.

The STOMP study confirmed that selinexor combined with pomalidomide/dexamethasone regimen was effective and well tolerated in the early treatment of RRMM.

The CPT-MM301 study confirmed that CPT combined with thalidomide/dexamethasone is effective in the treatment of relapsed and refractory multiple myeloma.

The PFS of the patient was extended from 3.
1 months to 5.
5 months, and the OS was extended from 17 months to 21.
8 months.

At the 2020 ASH conference, a large number of new research data was published on the treatment of multiple myeloma, and Professor Chen Wenming summarized the valuable research.

In terms of RRMM, CAR-T cell therapy has generally shown good efficacy and relatively controllable safety.

In addition, Professor Chen Wenming emphasized that the multi-drug combination strategy is still a better choice.

Professor Chen Wenming Chief Physician, Professor, Doctor of Medicine, PhD Supervisor, Director of the Department of Hematology, Beijing Chaoyang Hospital, Capital Medical University, Director of Beijing Multiple Myeloma Medical Research Center, Director of the Department of Hematology, Capital Medical University, Consultant of the International Myeloma Working Group and China Multiple Myeloma Working Group Expert Committee Member of the Hematology Professional Committee of China Medical Education Association Member of the Standing Committee of the Hematology Branch of the Chinese Integrative Medicine Association Member of the Standing Committee of the Hematology Branch of the Chinese Geriatrics Association Member of the Hematology Branch of the Chinese Medical Association Hematopoietic Stem Cells Member of the Transplantation Group, Member of the Hematology and Tumor Branch of the Chinese Anti-Cancer Association, stamp "read the original text", we will make progress together