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R. Mina et al.
AB
C
Figure 1. Standard-risk versus high-risk patients. (A) Progression-free survival (PFS), (B) PFS-2, and (C) overall survival (OS).
negative impact of HiR cytogenetics and ameliorate the prognosis of transplant-ineligible MM patients carrying HiR CA.
Our results showed similar ORR and CR/stringent CR rates between SR and HiR patients according to the cyto- genetic profile, as well as no significant differences in terms of PFS, PFS-2 and OS between the two groups. Furthermore, KCyd seemed to mitigate the poor progno- sis conferred by del17p in terms of PFS, PFS-2 and OS.
In Europe, Rd and VMP are currently the first-line regi- mens of choice for the treatment of older NDMM patients. To date, however, no prospective data on the comparison of VMP and Rd have been published, and the results of the first prospective, phase IV trial comparing these two standards of care are awaited (clinicaltrials.gov identifier: NCT03829371). However, we have recently pub- lished a pooled analysis of two phase III studies in which patients were treated either with VMP or Rd plus lenalido- mide maintenance (Rd-R), showing a PFS (HR: 0.54) and
OS (HR: 0.73) advantage in HiR patients receiving borte- zomib upfront.22 These results were in line with those generated in another phase III study in the transplant set- ting, in which bortezomib partially improved the poor prognosis of HiR patients carrying t(4;14) and/or del17p.23
In the ASPIRE trial, the addition of carfilzomib to Rd (KRd) improved the median PFS of approximatively 10 months compared to Rd in patients with HiR cytogenet- ics, although median PFS in HiR patients treated with KRd (23 months) remained approximatively 6 months shorter than in SR patients (29 months).17 In the ENDEAVOR trial, the doublet Kd proved to be superior to Vd in HiR patients (HR for PFS: 0.64, 95%CI: 0.45-0.92; P=0.007), although median PFS was inferior in HiR versus SR patients receiv- ing Kd (8.8 months vs. NR, respectively).16 In HiR RRMM patients, ixazomib in combination with Rd also proved to be effective as compared to Rd (HR 0.54, 95%CI: 0.32- 0.91; P=0.021), with similar median PFS in HiR and SR patients treated with this triplet (21.4 and 20.6 months,
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