guaranteed for patients with MM.
“A challenge in sequencing myeloma
treatment is the diminishing effectiveness
of each successive line of treatment, with
a shorter period of disease response with
[subsequent] therapy,” Drs. Yee and Raje
pointed out. “Furthermore, patients who
are refractory to newer agents such as
lenalidomide and bortezomib have histori-
cally had a poor prognosis.”
Dr. Rajkumar agreed that sequenc-
ing in these patients can be difficult and
outlined a preferred sequence for relapse in
an editorial in the New England Journal of
Medicine: 6
• If patients are deemed too frail for
these regimens, then ixazomib or
elotuzumab could be used in place of
daratumumab or carfilzomib (IRD
and ERD, respectively).
• In first relapse among patients who
are not refractory to lenalidomide, use
a combination of daratumumab, le-
nalidomide, and low-dose dexametha-
sone or carfilzomib, lenalidomide, and
dexamethasone.
• For those who are refractory to le-
nalidomide but not frail, try a combi-
nation of doxorubicin, vincristine, and
dexamethasone or bortezomib, cyclo-
phosphamide, and dexamethasone.
S:6.75”
• For frail patients, pembrolizumab
and dexamethasone, with or without
ixazomib, is another option.
Recent approvals of monoclonal antibod-
ies, including elotuzumab and daratu-
mumab, have broadened the treatment
landscape for all patients with myeloma.
The toxicities associated with these agents
tend to occur early in treatment. In pivotal
trials, infusion reactions were the most
BOSULIF offers proven efficacy for patients with resistance or intolerance to prior therapy 2
In 2nd-line treatment, after imatinib (n=266 evaluable) a
34
%
of patients
53
%
of patients
achieved MCyR at 6 months achieved MCyR with a minimum
follow-up of 23 months
(95% CI: 28.2, 39.9)
Median duration of MCyR was not
reached at the time of analysis
53% of patients with MCyR maintained
MCyR for at least 18 months (with a
minimum follow-up of 23 months)
In 3rd-line treatment, after imatinib followed by nilotinib and/or dasatinib therapy (n=108 evaluable)
• 27% of patients achieved MCyR by 6 months (95% CI: 18.8, 36.2)
• 32% of patients achieved MCyR with a minimum follow-up of 13 months
• Median duration of MCyR was not reached at the time of analysis
— 51% of patients with MCyR maintained MCyR for at least 9 months (with a minimum follow-up of 13 months)
BOSULIF has a distinct safety and