Salvage treatment patterns in multiple myeloma patients progressing after lenalidomide maintenance: A real‐life study from European Myeloma Network ( <scp>EMN</scp> ) Italy

The extensive use of lenalidomide (Len) in the first-line treatment of multiple myeloma (MM) has resulted in an increased frequency of patients who have been exposed or are refractory to Len (Len-R) at first relapse. However, the outcome of Len-R patients treated at first relapse after autologous haematopoietic stem cell transplantation (AHSCT) remains unclear. The aim of this real-life study is to evaluate the effectiveness of the regimens licensed in Italy and used in a cohort of patients who relapsed during Len maintenance after AHSCT. We collected 306 patients with these features. Considering the different regimens used, most patients received isatuximab-carfilzomib-dexamethasone (Isa-KD) (45.4%) followed by daratumumab-pomalidomide-dexamethasone (D-PD) (19.3%) and daratumumab-bortezomib-dexamethasone (D-VD) (12.4%). Overall, a reduced progression-free survival (PFS) and overall survival (OS) were observed in patients with high-risk disease features at relapse, including high lactate dehydrogenase (LDH) (p = 0.0003 and p < 0.0001), International Staging System (ISS) ≥2 (p < 0.0001 and p < 0.0001) and early relapse (<12 months from maintenance initiation) (p = 0.0017 and p = 0.0009). Considering the type of treatment, anti-cluster of differentiation 38 (CD38) monoclonal antibodies (anti-CD38 MoAb)-based regimen displayed improved survival compared to the other treatment, with Isa-KD reporting the longest PFS (22.8 months). Our data in a homogenous cohort of Len-R patients treated at first relapse demonstrated that the anti-CD38 MoAb-based combinations, particularly Isa-KD, represented the standard of care before the approval of anti-B cell maturation antigen (BCMA) immunotherapy.

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Journal
British Journal of Haematology
Published
2026-08-18
DOI
https://doi.org/10.1111/bjh.70751
Primary Topic
Multiple Myeloma Research and Treatments
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article
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article

Salvage treatment patterns in multiple myeloma patients progressing after lenalidomide maintenance: A real‐life study from European Myeloma Network ( EMN ) Italy

Concetta Conticello, Roberto Mina, B. Rossini, Gabriele Buda et al.
British Journal of Haematology
Multiple Myeloma Research and Treatments
article

Salvage treatment patterns in multiple myeloma patients progressing after lenalidomide maintenance: A real‐life study from European Myeloma Network ( EMN ) Italy

Concetta Conticello, Roberto Mina, B. Rossini, Gabriele Buda, Enrica Antonia Martino, Francesco Vassallo, Massimo Gentile, Ombretta Annibali, Lorenzo De Paoli, Giuseppe Pietrantuono, Claudio De Magistris, Valeria Ruocco, Edoardo Scomazzon, Anna Maria Cafro, Silvia Mangiacavalli, Pellegrino Musto, Giuseppe Mele, Martina Tinelli, Alberto Tosetto, Paola Boggione, Emanuele Favero, Angela Grassi, Elena Zamagni, Roberta Della Pepa, Martina Gherardini, Valeria Tomarchio, Claudio Salvatore Cartia, Antonia Cagnetta, Renato Zambello, Massimiliano Arangio Febbo, Francesca Fazio, Carmine Liberatore, Gregorio Barilà, Elisabetta Antonioli, Nicola Sgherza, Laura París, Maria Livia Del Giudice, Anna Furlan, Mónica Galli, Massimo Offidani, Maria Luisa Pioltelli, Sara Pezzatti, Edoardo Olivari, Sonia Morè, Marco Talarico, Francesco Pisani, Maria Teresa Petrucci, Francesca Patriarca, Francesca Fioritoni
article en

Abstract

The extensive use of lenalidomide (Len) in the first-line treatment of multiple myeloma (MM) has resulted in an increased frequency of patients who have been exposed or are refractory to Len (Len-R) at first relapse. However, the outcome of Len-R patients treated at first relapse after autologous haematopoietic stem cell transplantation (AHSCT) remains unclear. The aim of this real-life study is to evaluate the effectiveness of the regimens licensed in Italy and used in a cohort of patients who relapsed during Len maintenance after AHSCT. We collected 306 patients with these features. Considering the different regimens used, most patients received isatuximab-carfilzomib-dexamethasone (Isa-KD) (45.4%) followed by daratumumab-pomalidomide-dexamethasone (D-PD) (19.3%) and daratumumab-bortezomib-dexamethasone (D-VD) (12.4%). Overall, a reduced progression-free survival (PFS) and overall survival (OS) were observed in patients with high-risk disease features at relapse, including high lactate dehydrogenase (LDH) (p = 0.0003 and p < 0.0001), International Staging System (ISS) ≥2 (p < 0.0001 and p < 0.0001) and early relapse (<12 months from maintenance initiation) (p = 0.0017 and p = 0.0009). Considering the type of treatment, anti-cluster of differentiation 38 (CD38) monoclonal antibodies (anti-CD38 MoAb)-based regimen displayed improved survival compared to the other treatment, with Isa-KD reporting the longest PFS (22.8 months). Our data in a homogenous cohort of Len-R patients treated at first relapse demonstrated that the anti-CD38 MoAb-based combinations, particularly Isa-KD, represented the standard of care before the approval of anti-B cell maturation antigen (BCMA) immunotherapy.

British Journal of Haematology
University of Pisa (IT), University of Verona (IT), Marche Polytechnic University (IT), Università degli Studi del Piemonte Orientale “Amedeo Avogadro” (IT), University of Udine (IT), University of Padua (IT), Università Campus Bio-Medico (IT), Policlinico Umberto I (IT), Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico (IT), University of Catania (IT), University of Chieti-Pescara (IT), Azienda Ospedaliera Citta' della Salute e della Scienza di Torino (IT), Centro di Riferimento Oncologico della Basilicata (IT), Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda (IT), Azienda Universitaria Ospedaliera Consorziale - Policlinico Bari (IT), Azienda Ospedaliera di Cosenza (IT), Ospedale A. Perrino (IT), Ospedale Papa Giovanni XXIII (IT), Ospedale di Santo Spirito (IT), Istituto Oncologico Veneto (IT), Azienda Ospedaliera San Gerardo (IT), Azienda Ospedaliero-Universitaria Careggi (IT), Federico II University Hospital (IT), Istituto di Ematologia di Bologna (IT), Policlinico Universitario di Catania (IT), Istituto Tumori Bari (IT), National Cancer Institute (MY), Azienda Sanitaria Ospedaliera S.Croce e Carle Cuneo (IT), Ca' Foncello Hospital (IT), Ospedale Policlinico San Martino (IT), Policlinico San Matteo Fondazione (IT), Ospedale San Bortolo (IT), Istituti di Ricovero e Cura a Carattere Scientifico (IT), University of Calabria (IT), University of Bari Aldo Moro (IT), University of Bologna (IT)
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