Combination of Elotuzumab, Lenalidomide, and Dexamethasone in High-Risk Patients with Smouldering Multiple Myeloma

Oral presentation by Dr. Irene M. Ghobrial

In Canada, there is no currently funded treatment option for patients with high-risk smouldering multiple myeloma (MM). Patients require careful investigation to ensure there are no elements of symptomatic myeloma according to International Myeloma Working Group criteria, but at the present time, patients with smouldering myeloma are managed with active surveillance.

In this phase II trial of combination elotuzumab, lenalidomide, and dexamethasone, 40 patients with high-risk smouldering MM were evaluated. At a median follow-up of 29 months, progression-free survival (PFS) has not yet been reached, while the 36-month PFS was 95%. However, a historical comparison based on previous publications on the use of lenalidomide and dexamethasone alone demonstrated a 36-month PFS of 70%. There was no difference in treatment responses in patients with high-risk cytogenetics and no overall survival data was yet available. The most common grade 3 adverse event was hypophosphatemia. Diabetic ketoacidosis and sepsis led to death in one patient.

At the present time, Canadian focus remains on the accurate diagnosis and monitoring of patients with smouldering MM. As the data for treatment of high-risk smouldering myeloma patients grows, Canadian treatment options will likely need to be re-evaluated. The landscape of smouldering myeloma is changing with improved diagnostic abilities, such as positron emission tomography/computed tomography and magnetic resonance imaging. While the ability to intervene in a pre-symptomatic state is appealing, hopefully genomics will help to determine which patients will progress to overt myeloma and will best respond to treatment at an earlier state.

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