Salvage treatment patterns in multiple myeloma patients progressing after lenalidomide maintenance: A real‐life study from European Myeloma Network (
EMN
) Italy
Gregorio Barilà, Angela Grassi, Valeria Ruocco, Carmine Liberatore, Edoardo Olivari, Martina Tinelli, Francesca Fazio, Sonia Morè, Emanuele Favero, Claudio Salvatore Cartia, Nicola Sgherza, Concetta Conticello, Roberto Mina, Martina Gherardini, Giuseppe Mele, Massimo Gentile, Anna Furlan, Massimiliano Arangio Febbo, Maria Livia Del Giudice, Ombretta Annibali, Bernardo Rossini, Edoardo Scomazzon, Marco Talarico, Enrica Antonia Martino, Claudio De Magistris, Francesca Fioritoni, Anna Maria Cafro, Laura Paris, Sara Pezzatti, Roberta Della Pepa, Paola Boggione, Giuseppe Pietrantuono, Valeria Tomarchio, Francesco Vassallo, Maria Luisa Pioltelli, Francesco Pisani, Antonia Cagnetta, Lorenzo De Paoli, Gabriele Buda, Elisabetta Antonioli, Monica Galli, Alberto Tosetto, Pellegrino Musto, Elena Zamagni, Francesca Patriarca, Silvia Mangiacavalli, Renato Zambello, Massimo Offidani, Maria Teresa Petrucci Summary
The extensive use of lenalidomide (Len) in the first‐line treatment of multiple myeloma (MM) has resulted in an increased frequency of patients who have been exposed or are refractory to Len (Len‐R) at first relapse. However, the outcome of Len‐R patients treated at first relapse after autologous haematopoietic stem cell transplantation (AHSCT) remains unclear. The aim of this real‐life study is to evaluate the effectiveness of the regimens licensed in Italy and used in a cohort of patients who relapsed during Len maintenance after AHSCT. We collected 306 patients with these features. Considering the different regimens used, most patients received isatuximab–carfilzomib–dexamethasone (Isa‐KD) (45.4%) followed by daratumumab–pomalidomide–dexamethasone (D‐PD) (19.3%) and daratumumab–bortezomib–dexamethasone (D‐VD) (12.4%). Overall, a reduced progression‐free survival (PFS) and overall survival (OS) were observed in patients with high‐risk disease features at relapse, including high lactate dehydrogenase (LDH) ( p = 0.0003 and p < 0.0001), International Staging System (ISS) ≥2 ( p < 0.0001 and p < 0.0001) and early relapse (<12 months from maintenance initiation) ( p = 0.0017 and p = 0.0009). Considering the type of treatment, anti‐cluster of differentiation 38 (CD38) monoclonal antibodies (anti‐CD38 MoAb)‐based regimen displayed improved survival compared to the other treatment, with Isa‐KD reporting the longest PFS (22.8 months). Our data in a homogenous cohort of Len‐R patients treated at first relapse demonstrated that the anti‐CD38 MoAb‐based combinations, particularly Isa‐KD, represented the standard of care before the approval of anti‐B cell maturation antigen (BCMA) immunotherapy.