Dr. Cowan on Treatment Strategies in Transplant Eligible- and -Ineligible Myeloma

Andrew J. Cowan, MD, an assistant professor of medicine at University of Washington School of Medicine and hematologist/oncologist at Seattle Cancer Care Alliance, discusses treatment strategies for patients with transplant-eligible and -ineligible multiple myeloma.

Apart from whether or not a patient is transplant-eligible or not, treatment strategies do not differ dramatically, says Cowan. Three-drug regimens are increasingly becoming the mainstay of treatment for patients, whether they are eligible for transplant or not. However, frailer patients or those who have advanced-stage disease may be better suited to receive doublets such as lenalidomide (Revlimid) and dexamethasone or bortezomib (Velcade) and dexamethasone, says Cowan.

Clinicians do not have to be dogmatic about approaches, adds Cowan. Now, clinicians have data from the phase III MAIA trial. The results were presented at the 2018 ASH Annual Meeting and subsequently published. In the trial, patients with transplant-ineligible disease were randomized to receive daratumumab (Darzalex), a CD38-directed monoclonal antibody, lenalidomide and dexamethasone, or lenalidomide and dexamethasone alone. The results demonstrated that patients who received the triplet were 45% less likely to progress versus those who received the doublet. Notably, daratumumab does not cause a lot of neuropathy, making it a good option for patients who are frailer.