EHA 2024 – Highlights in multiple myeloma

In this video, Prof Dr Claudio Cerchione, haematologist at the Istituto Romagnolo per lo Studio dei Tumori in Meldola, Italy shares his congress highlights from EHA 2024 in the field of multiple myeloma (MM).

EHA 2024 featured many interesting presentations across different treatment lines in MM. In the frontline setting, especially the results of the BENEFIT trial caught the attention of Prof Cerchione. In this trial, transplant ineligible, newly diagnosed MM patients were treated with isatuximab-lenalidome and dexamethasone (Isa-Rd) with or without bortezomib (V). At the 18-month landmark, the rate of MRD negativity (10 ^-5) with Isa-VRd was reported at 47%, which was significantly better than the 24% seen with Isa-Rd (OR[95%CI]: 2.96[1.73-5.07; p< 0.001). The regimen was well-tolerated, with only 10% of patients who discontinued V due to adverse events.¹

Also the position of CAR-T cell therapy in the treatment of MM continues to evolve. In this respect, interesting data were presented from cohort D of the CARTITUDE-2 study, evaluating ciltacabtagene autoleucel (cilta-cel) with or without lenalidomide maintenance in patients with newly diagnosed multiple myeloma who achieved less than a complete response (<CR) after an autologous stem cell transplant (ASCT). This strategy led to high rates of durable responses (ORR 94%), and proved to be associated with an 18-month progression-free (PFS) and overall survival (OS) rate of 94%.²

In the relapsed refractory setting, several studies confirmed the potential of BCMA-directed bispecific antibodies in heavily pre-treated MM patients, including patients with triple refractory disease.^3-5

Also in the R/R setting, data from the phase III DREAMM-7 trial showed a statistically significant benefit in PFS with the combination of the anti-BCMA antibody drug conjugate belantamab vedotin with bortezomib and dexamethasone (BVd) compared to daratumumab + Vd (DVd) (median PFS: 36.6 vs. 13.4 months; HR[95%CI]: 0.42[0.31-0.53]; p< 0.0001). In addition, BVd came with a greater depth of response and a doubling of the median response duration compared to DVd. Furthermore, the BVd proved to be manageable.⁶

In the phase III DREAMM-8 trial, the combination of B with pomalidomide-dexamethasone (BPd) was compared to pomalidomide in combination with bortezomib and dexamethasone (PVd) in patients with RRMM. The B-based regimen led to a significant improvement in PFS (median not reached vs. 12.7 months; HR[95%CI]: 0.52[0.37-0.73]; p< 0.001) and a higher rate of complete responses or better (40% vs. 16%).⁷ Also in this trial, the treatment with belantamab vedotin came with a manageable safety profile.

For Prof Cerchione these therapeutic advances will force the MM community to once again rethink the optimal treatment sequence for patients with MM. To facilitate a better therapeutic tailoring in MM, his research group is integrating clinical data of MM patients with data from molecular, radiomic, genetic and metabolic analyses. The initial results of these research efforts were presented at EHA 2024.^8,9