Combination therapy with carfilzomib, lenalidomide and dexamethasone (KRd) results in an unprecedented purity of the stem cell graft in newly diagnosed patients with myeloma Journal Article


Authors: Tageja, N.; Korde, N.; Kazandjian, D.; Panch, S.; Manasanch, E.; Bhutani, M.; Kwok, M.; Mailankody, S.; Yuan, C.; Stetler-Stevenson, M.; Leitman, S. F.; Sportes, C.; Landgren, O.
Article Title: Combination therapy with carfilzomib, lenalidomide and dexamethasone (KRd) results in an unprecedented purity of the stem cell graft in newly diagnosed patients with myeloma
Abstract: Still, many physicians give 4 cycles of combination therapy to multiple myeloma patients prior to collection of stem cells for autologous bone marrow transplant. This tradition originates from older doxorubicin-containing regiments which limited the number of cycles due to cumulative cardiotoxicity. Using older regiments, most patients had residual myeloma cells in their autologous stem-cell grafts during collection. Emerging data show that newly diagnosed multiple myeloma patients treated with modern carfilzomib/lenalidomide/dexamethasone (KRd) therapy, on average, take 6 cycles until reaching minimal residual disease (MRD) negativity. We assessed newly diagnosed patients treated with KRd focusing MRD status both in the individual patient’s bone marrow, and the corresponding autologous hematopoietic progenitor cell grafts during collection. Per protocol, stem-cell collection was allowed after 4 to 8 cycles of KRd. We found similar stem-cell yield independent of the number of cycles of KRd. At stem-cell collection, 11/30 patients (36.6%) were MRD negative in their bone marrow; all 11 patients had MRD negative hematopoietic progenitor cell grafts. Furthermore, 18/19 patients who were MRD positive in their bone marrows also had MRD negative hematopoietic progenitor cell grafts. These observations support 6 cycles of KRd as an efficacious and safe induction strategy prior to stem-cell collection. © 2018, Macmillan Publishers Limited, part of Springer Nature.
Journal Title: Bone Marrow Transplantation
Volume: 53
Issue: 11
ISSN: 0268-3369
Publisher: Nature Publishing Group  
Date Published: 2018-11-01
Start Page: 1445
End Page: 1449
Language: English
DOI: 10.1038/s41409-018-0170-0
PROVIDER: scopus
PUBMED: 29728700
DOI/URL:
Notes: Bone Marrow Transplant. -- Export Date: 2 January 2019 -- Article -- CODEN: BMTRE -- Source: Scopus
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MSK Authors
  1. Carl Ola Landgren
    175 Landgren
  2. Neha Sanat Korde
    56 Korde