Autologous stem cell transplantation (ASCT) continues to play a crucial role in the treatment of multiple myeloma, particularly for high-risk patients, according to Dr. Marc J. Braunstein of NYU Langone Health – Long Island. One emerging trend in the current patient population is the use of quadruplet regimens, but the existing randomized data fails to conclusively determine whether these patients still require stem cell transplantation. While most studies have focused on triplet regimens, the question of whether quadruplet induction can eliminate the need for stem cell transplant remains a pressing concern.
The selection of the optimal proteasome inhibitors (PIs) for induction treatment is also a subject of ongoing debate in the medical community. Studies have examined the use of carfilzomib (Kyprolis) in both triplet and quadruplet regimens, consistently showing benefits with this agent. Similarly, integrating lenalidomide (Revlimid), bortezomib (Velcade), and dexamethasone, with or without a monoclonal antibody, has yielded positive outcomes. However, a dearth of head-to-head data exists, specifically comparing triplet induction regimens featuring either bortezomib or carfilzomib as the PI of choice. Furthermore, studies investigating triplet regimens in patients who did not undergo stem cell transplant have failed to demonstrate significant differences in outcomes between triplets containing bortezomib or carfilzomib in the upfront setting.
Overall, these findings highlight the need for further research to better understand when ASCT should be recommended for multiple myeloma patients. Determining the efficacy of quadruplet regimens, the optimal choice of PIs, and the impact of stem cell transplantation on treatment outcomes are crucial areas to address in order to optimize the management of this disease.