Salvage autologous stem cell transplantation in daratumumab refractory multiple myeloma (MM).

• DOI: 10.1200/jco.2021.39.15_suppl.e20031
• Publication Date: 2021-06-02T14:47:40Z
• Authors: Lakshmi Yarlagadda; Sravani Gundarlap...; Richa Parikh; Mathew Kottarathara; Yetunde Ogunsesan; Shadiqul Hoque; Angel Mitma; Clyde Bailey; Kerri Hill; Sharmilan Thanend...; Monica Grazziutti; Meera Mohan; Maurizio Zangari; Frits Van Rhee; Guido Tricot; Carolina D. Schinke
• Keywords: Daratumumab; Melphalan; Autologous stem-cell transplantation; Pomalidomide; Ixazomib; Regimen; Salvage therapy; Progression-free survival

e20031 Background: The advent of novel therapies has significantly improved outcomes in MM, yet most patients will eventually relapse. Patients progressing on CD38-targeting monoclonal antibodies, proteasome inhibitors (PIs) and IMiDs have dismal outcome. While treatment modalities based mechanisms shown promising results, the current study explores use high dose chemotherapy followed by autologous stem cell transplantation (ASCT) these heavily pretreated MM patients. Methods: We investigated outcome 57 who received salvage ASCT after progression Daratumumab. All had also been exposed to at least two PIs IMiDs. assessed overall response using IMWG criteria, minimal residual disease (MRD) 8 color flow cytometry with a sensitivity 10 -5 , free (PFS) survival (OS). Results: Median age patient cohort was 62 years (39-75) all Daratumumab, Thalidomide, Revlimid Velcade. 93% (53/57), 91% (52/57) 32% (18/57) Carfilzomib, Pomalidomide Ixazomib respectively. Pre-ASCT conditioning regimen included melphalan 23% (13/57), combination VDT-PACE (Velcade, Dexamethasone, Cisplatin, Adriamycin, Cytoxan Etoposide) 30% (17/57) BEAM (BCNU, Etoposide, Ara-C Melphalan) 47% (27/57). Post-ASCT 90% (51/57) within 100 days ASCT. Overall rate 81% (46/57) CR 39% (22/57), VGPR (13/57) PR 19% (11/57). Stable seen 3.5% (2/57) progressive 5% (3/53) MRD negativity attained 44% (25/57) patients, whom VGPR. After assessment, were started maintenance combinations either previously used agents (pomalidomide [20/57], carfilzomib [11/57] CD38 moAbs [16/57]) or no little prior exposure (cytoxan [11/57], selinexor [4/57] venetoclax [3/57]). median PFS for entire 8.5 months OS 19.6 months. For ≥ VGPR, 11 24.9 Achievement did not improve outcome, = 20 17% (10/57) still alive 36months post Conclusions: High achieves substantial responses 17.5 % 3 years. results suggest role selected pre-treated albeit there remains an obvious clinical need therapies. achievement further impact our study, although that may be due relative small number major overlap between ≥VGPR negativity.