Comparing Consolidation and Maintenance vs Maintenance Alone for Newly Diagnosed MM

A recent study comparing consolidation treatment with bortezomib, lenalidomide, and dexamethasone (VRD) followed by lenalidomide maintenance vs no consolidation suggests that consolidation may improve progression-free survival (PFS) and depth of response in patients with newly diagnosed multiple myeloma (MM; J Clin Oncol. 2021; 39[32]:3613-3622. doi:10.1200/JCO.21.01045).

In this study, Pieter Sonneveld, MD, Department of Hematology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands, and colleagues aimed to “address the role of consolidation treatment for newly diagnosed, transplant eligible patients with [MM] in a controlled clinical trial.” 

Researchers compared consolidation with two cycles of VRD vs no consolidation after induction and intensification therapy, followed by continuous lenalidomide maintenance. The primary end point of the study was PFS.

A total of 878 patients were randomized to receive VRD (n = 451) or no consolidation (n = 427). At a median follow-up of 74.8 months, the median PFS with adjustment for pretreatment was 59.3 months in patients randomly assigned to VRD consolidation, and 42.9 months in those randomly assigned to no consolidation.

The PFS benefit was observed in a majority of predefined subgroups, and revised ISS3 stage and ampl1q were adverse prognostic factors. The median duration of maintenance was 33 months, and a response comparable to or higher than complete response after consolidation was 34%, with VRD consolidation and 18% in no consolidation before start of maintenance. A response comparable to or higher than complete response on protocol including maintenance with consolidation vs without was 59% and 46%, respectively. 

In a subgroup of 226 patients with complete response, stringent complete response, or very good partial response before start of maintenance, there was a 74% minimal residual disease–negativity rate in patients who received VRD. 

“Consolidation treatment with VRD followed by lenalidomide maintenance improves PFS and depth of response in newly diagnosed patients with [MM] as compared to maintenance alone,” concluded Dr Sonneveld and colleagues.