Lenalidomide Maintenance and MRD 100 Days Post ASCT Predict PFS in Real-World Patient Cohort in Brazil

In what the authors believe to be the first reported study in Latin America of next-generation flow cytometry for MRD monitoring of multiple myeloma (MM) therapy – and one of the first real-world studies of this treatment monitoring strategy – lenalidomide maintenance therapy (M-Len) and MRD status at 100 days post autologous stem cell transplantation (ASCT) were independent predictors of progression-free survival (PFS) in a real-world patient cohort in Brazil. The paper by Angelo Maiolino, MD, PhD, of the Federal University of Rio de Janeiro and colleagues was published in Cancers in March.

Among 53 patients (26 male, median age 58) not treated in clinical trials, from whom peripheral blood, bone marrow, and 24-hour urine samples were collected 100 days after ASCT and analyzed using 8-color NGF with a sensitivity threshold of 2 x 10-6, 60% were MRD positive. Rates of MRD positivity were similar among patients who received M-Len (11/18; 61%) and those did not (21/35; 60%). Median PFS for MRD-positive patients was 31 months versus not reached (NR) for those who were MRD negative. Median PFS was NR for patients who received continuous M-Len (18 of 53; 30%) versus 29 months for those who did not.

After 34 months of follow-up, 54% of patients who did not receive M-Len had progressive disease, compared with 11% of those who did. Among MRD-negative patients who did not receive M-Len, 43% had disease progression. No deaths occurred among patients treated with M-Len, whereas 11/35 (31%) of those who did not receive M-Len died.

“In real-world patients with MM treated in Brazil, the introduction of M-Len post-ASCT is associated with significantly improved survival outcomes, with MRD monitoring via NGF emerging in these settings as a robust and powerful tool to identify subsets of patients with different (higher vs. lower) risks of early relapse and for anticipated treatment decisions,” the authors concluded.

  • Salgado ABDS, Magalhães RJP, Pontes RM, et al. Lenalidomide Maintenance and Measurable Residual Disease in a Real-World Multiple Myeloma Transplanted Population Receiving Different Treatment Strategies Guided by Access to Novel Drugs in Brazil. Cancers (Basel). 2023;15(5):1605. Published 2023 Mar 4. doi:10.3390/cancers15051605

Tags: MRD, multiple myeloma, MRD testing, Survival, MRD negativity, survival rate, MM, measurable residual disease

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