Towards Response-Adaptive Changes in Induction Therapy to Improve Survival Outcomes in Transplant Eligible Multiple Myeloma Patients

Bortezomib (V) - based triplet regimens are considered the standard of care induction regimens for transplant eligible multiple myeloma (TEMM) patients in the US, achieving >VGPR rates of ∼60-70%. Recently, two phase II studies of carfilzomib-lenalidomide-dexamethasone (KRd) induction for TEMM (Zimmerman et al & Roussel et al, ASH 2016) with >VGPR rates in over 90%. Suboptimal response to induction appears to influence post-transplant response and survival outcomes. Our center utilizes a response-adaptive change in proteasome inhibitor (from V to K) for suboptimal response pre-transplant. Herein, we are reporting the impact of this approach on post-transplant outcomes.