Quadruplet Therapy for Treatment of Newly Diagnosed Transplant-Eligible Multiple Myeloma
Melissa Alsina, MD, Moffitt Cancer Center, Tampa, Florida, discusses quadruplet therapy as the optimal choice for newly diagnosed multiple myeloma among patients who are transplant-eligible, with the goal of achieving minimal residual disease (MRD) at the 2025 Lymphoma, Leukemia & Myeloma (LL&M) Winter Symposium in Miami, Florida.
Transcript:
Good afternoon. My name is Melissa Alsina. I'm one of the myeloma physicians at Moffitt Cancer Center in Tampa. I'm here at the Leukemia, Lymphoma, & Myeloma Winter Symposium. I just gave a talk about the treatment of newly diagnosed myeloma in patients that are transplant-eligible.
One of the most important parts of my talk is how long we've come overall, over 3 decades. We went from having a median survival of less than 3 years, to 85% of the patients without disease at 4 years. It's really dramatic. The reason we are here at this point is because of the very important research that has been done and better understanding of the disease. That has led to the approval of many, many different drugs for the treatment of myeloma.
The drugs that have impacted more, are the immunotherapies, particularly the CD38 monoclonal antibodies. I discussed several studies that showed that using a quadruplet as induction therapy, including an immunomodulatory drug, a proteasome inhibitor, dexamethasone, and a CD38 antibody, really has positively impacted the progression-free survival (PFS) of the patients.
The other very important aspect is minimal residual disease. Evaluation of minimal residual disease has become very important. Many studies have shown that achieving MRD negativity favors survival and progression-free survival. In 2025, the goal of therapy should be to get the patients to MRD negativity. The best way to achieve that is to offer the patients a quadruplet as induction therapy followed by transplanting the majority of the patients. Then, following an MRD and risk-adapted approach, despite all the significant advances, there's still a lot of work to do.
Number 1, we still are not curing myeloma. Number 2, we have some patient populations that still don't benefit as much as we would like, like high-risk disease. New studies, new approaches for these patients are definitely needed, as well as better ways to characterize the disease because we can characterize the majority of the patients, but there's still patients that do not respond well to therapy, and we really don't have a good grasp on what is leading that resistance. Again, there's still a lot of work to do, a lot of work to do.
Participation in clinical trials continues to be very important. Right now, in the newly diagnosed, the most exciting clinical trials, in my opinion, are those studies that are comparing induction therapy, followed by transplant versus induction therapy, followed by CAR-T. These studies will take some time to give us a readout, but once they come, they could be really, practice changing.
In summary, to mention 3 things we need to keep in mind right now, number 1, every newly diagnosed myeloma patient that is considered for transplant should get a quadruplet. Number 2, the goal of therapy should be MRD negativity. And number 3, if you have a high-risk patient, still consider a clinical trial for those patients because we know that the standard of care has not given us the best results.
Source:
Alsina M. Updates in Front Line – Transplant Eligible Multiple Myeloma. Presented at Lymphoma, Leukemia & Winter Symposium; February 7-9, 2025. Miami, FL.
